Novel Score for Prediction of Contrast Induced Nephropathy after Percutaneous Coronary Interventions
Authors: Gafaar Nourhan Abo EL-Qassim Ahmed , Tamara Ahmed Mohammed Fathy , El-Fekky Ehab Mohamed , AhmedTantawy Mahmoud 
Published: August 2023

Background

CIN is one of the most important PCI complications with higher mortality so it is important to early detect high risk patients for CIN and prevent it’s occurrence. However, CHA2DS2VASc score neglects important factors as (S.creatnine, eGFR, Anemia, contrast volume, SBP&lt;80 mmhg, IABP) that found in Mehran. Mehran score neglects factors which increase CIN risk as (HTN, Female gender, vascular element, stroke) and found in CHA2DS2-VASc.

Aim

To evaluate a novel score (SPADC2H) for CIN prediction after PCI using variables in MRS, CHADS-VASc scores and PCI urgency to be used on patients with ACS and stable CAD.

Methods

This study is conducted over 500 patients as follow: (Study sample 250 patients, number of population that are experimented for the novel score development, provided that the CIN incidence ranging from 7% to25% (average 13.20%) after PCI. Then we validate the score on 250 patients). We analyzed whole patient’s data, CHADSVASc, MRS scores then followed up patient’s creatinine level daily for 48 hr after PCI for CIN development then compared these data in CIN versus non CIN patients trying to find out the most independent variables that can predict CIN developing a novel score.

Results

From the 500 patients (n = 250 study population, 250 validation). All Variables included in the model for CIN prediction: (Age ≥ 65 years, Female sex, Hypertension, DM, Stroke, HCM, Aortic plaque, Old IHD, TIA, PAD, EF ≤ 40%, Primary PCI, Contrast volume ≥ 200 ml, SBP ≤ 80 mmHg, eGFR&lt;60 ml/min, Baseline creatinine &gt;1.5 mg/dl, Anemia). Variables that include: Female gender (p-value = 0.009), DM (p-value = 0.002), PAD (p-value = 0.021), Contrast volume ≥200 ml (p-value = 0.060), SBP ≤80 mmHg or need for inotropes (p-value = 0.0005), and baseline creatinine &gt;1.5 mg/dl (p-value = 0.0005) are retained in the model as significant independent factors. Variables that include: Age ≥65years (p-value = 0.021, male (p-value = 0.004), Hypertension (p-value = 0.029), EF ≤ 40% (p-value = 0.010), NYHAIII/IV (p-value = 0.185), Primary PCI (p-value = 0.037), eGFR&lt;60ml/min (p-value= 0.015) and Anemia (p-value = 0.003) are significant variables but are all extruded from the model during stepwise iterations by (multivariable backward binary logistic regression model) as dependent factors for CIN prediction. Variables that include: Stroke (p-value=0.565), DVT (p-value=0.947), Old IHD (p-value=0.616) are non-significant variables. Variables that include: TIA, IABP, HCM, Aortic plaque are limited in the study. IN experimental study (n.250 p.). A total score of &gt; 3 is associated with the highest Youden index (J = 0.442), with a sensitivity of 52.5%, specificity of 91.6% and accuracy of 82.4%. IN validation study (n.250 p.). A total score of &gt; 3 is associated with the highest Youden index J = 0.641), with a sensitivity of 72.6%, specificity of 91.5% and accuracy of 86%.

Conclusion

Novel simple risk score for CIN prediction. Comparison between the three (MRS, Novel, CHADS-VASC) scores.

Abbreviations

ABI: Ankle brachial index; ACS: Acute coronary syndrome; AF: Atrial fibrillation; CAD: Coronary artery disease; CHF: congestive heart failure; CIN: Contrast-induced nephropathy; CM: contrast medium; CTO: Chronic total occlusion; CV: Cardio-vascular; DM: Diabetes Mellitus EF: Ejection fraction; eGFR: Estimated glomerular filtration rate; ESC: Europian society of cardiology; HTN:. Hypertention; IABP: Intra-aortic balloon pump; IQR: Inter quartile range; LAD:. Left anterior descending; LCX: Left circumflex; LEAD: Lower extremity artery disease; MDRD: Modification of diet in renal disease MI: Myocardial infarction