Author + information
- Yuanhui Liu,
- Yong Liu,
- Ji-yan Chen and
- Ning Tan
Accurate risk stratification for contrast-induced nephropathy (CIN) is important in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We aimed to compare the prognostic value of validated risk scores for CIN.
We prospectively enrolled 422 consecutive patients treated with primary PCI for STEMI. Mehran, Gao, Chen, Age, Creatinine (SCr), and Ejection Fraction (ACEF); Age, Glomerular Filtration Rate, and Ejection Fraction (AGEF); and GRACE risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (rise in SCr ≥ 0.5 mg/dL) or CIN-broad (rise in SCr ≥0.5 mg/dL) and/or a ≥ 25% increase in baseline (SCr).
These six risk scores all had relatively high predictive value for CIN-narrow (C statistic range 0.746 to 0.873), as well with good calibration for most of them. In addition, these six risk scores also displayed well for prediction of in-hospital death (0.784 to 0.936) and in hospital MACEs (0.685 to 0.763) or 3 year all-cause mortality (0.655 to 0.871). ACEF and AGEF risk score have both better discrimination and calibration for CIN-narrow, in-hospital outcomes, comparing with other risk scores. However, these six risk score all did not perform as well and had low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619).
Risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in STEMI patients undergoing primary PCI. The ACEF and AGEF risk scores appear to have greater prognostic value.