The PRECISE-DAPT Score as a Predictor of Constrast Induced Nephropathy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention
Authors: Essa Mohamed Abdulghany Ibrahim , Elhammady Walid Abdel Azim , Fekky Ehab Mohamed El 
Published: August 2023

Abstract

Background
In the ACS population, there are inherent difficulties in rapidly assessing CIN risk and instigating prophylactic measures. Moreover, these procedures often use increased contrast volume and the patients are more likely to be haemodynamically compromised, increasing their risk of renal impairment. This was a prospective observational cohort study conducted on 200 patients with acute coronary syndrome (ACS), and undergoing percutaneous coronary intervention (PCI); to evaluate the predictive value of PRECISE DAPT score for the development of contrast induced nephropathy (CIN).

Aim of the Work
To evaluate the predictive value of PRECISE DAPT score for the development of CIN in ACS patients undergoing PCI, and compare its predictive power to Mehran score, and to contrast volume/eGFR ratio.

Patients and Methods
A total of 200 patients who were diagnosed with ACS and undergoing PCI, were recruited from Ain Shams University Hospitals and enrolled in the study. The primary endpoint was the development of CIN after PCI. CIN defined as an increase of &gt; 25%, and/or &gt; 0.5 mg/dl in serum creatinine at 3-5 days after PCI when compared to baseline value.

Results
The median age of all patients was (55) years, the majority (74.5%) of patients were males; while (25.5%) were females; (6.5%) of patients had positive family history of CAD, (35.5%) had DM, (42%) had HTN, (18.5%) had Dyslipidemia, (10%) had history of anemia, and (10.5%) had previous indexed MI The median Contrast volume was 180 ml, the median duration of procedure was (50 min). LAD was the culprit artery in (65.5%) of cases, RCA in (21.5%) of cases, LCX in (13 %) of cases. (10.5%) of patients suffered post procedural CIN (n = 21), (3%) of patients had No reflow, (4.5%) had Major bleeding, (27.5%) had Minor bleeding, and (25%) had Acute Heart Failure. The average Mehran score was 5 (range from 1 to 28), the average PRECISE DAPT score was 18(range from 2 to 60), PRECISE-DAPT score showed excellent predictive value for CIN development (AUC = 0.91, 95% CI = 0.86 to 0.94, P &lt; 0.0001). Best cut-off is score &gt;27 (sensitivity = 85.7%, 95% CI = 63.7% - 97.0%, specificity = 87.7%, 95% CI = 82.0% - 92.1%; Jindex = 0.73). PRECISE-DAPT was superior to both Mehran score (ΔAUC = 0.12, P = 0.018) and CV/eGFR (ΔAUC = 0.19, 95%, P = 0.018). There was no statistically significant difference between Mehran and CV/eGFR. (ΔAUC = 0.07, P = 0.304).

Conclusion
PRECISE-DAPT score showed excellent predictive value in predicting the development of (CIN) in ACS population, AUC = 0.91 (P &lt; 0.0001). Best cut-off is score &gt; 27 (sensitivity = 85.7%, specificity = 87.7%), exceeding Mehran score and CV/eGFR ratio. Validation of Mehran score in ACS was achieved. It showed good predictive value, AUC = 0.79 (P &lt; 0.0001). Best cut-off is Mehran score &gt; 6 (sensitivity = 81.0%, specificity = 67.6%). There is no statistically significant difference between Mehran and CV/eGFR. Logistic regression analysis showed that; serum creatinine level pre-PCI, wall motion score index, LAD infarction, and PRECISE DAPT score; all had an independent effect on increasing the probability of CIN occurrence; with significant statistical difference (p &lt; 0.05 for all).

Abbreviations
ACEI: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; AHA: American Heart Association; AKI: Acute kidney injury; AMI: Acute myocardial infarction; CI-AKI: Contrast-induced acute kidney injury; CIN: Contrast-induced nephropathy; CK-MB: Creatine kinase myocardial band; CM: Contrast media; CV/GFR: Contrast Volume/eGFR Ratio: Estimated Glomerular Filtration Rate.; DBP: Diastolic blood pressure; DM: Diabetes mellitus; EF: Ejection fraction; Gp: Glycoprotein; Hb: Hemoglobin; HOCM: High osmolar contrast media; IABP: Intra-aortic balloon; IQR: Inter-quartile range; LAD: Left anterior descending artery; LCX: Left circumflex coronary; MAP: Mean arterial blood pressure. MI: myocardial infarction.; MBG: Myocardial blush grade; MINOCA: Myocardial infarction in the absence of obstructive coronary artery disease; NSTEMI: Non-ST elevation myocardial infarction; PCI: Percutaneous coronary intervention; PLT: Platelets; RCA: Right coronary artery; ROC curve: Receiver operating characteristic analysis; SD: Standard deviation; STEMI: ST-segment elevation myocardial infarction; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery; TIMI: Thrombolysis in Myocardial Infarction; TLC: Total leucocytic count