Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Basic Clin Pharmacol Toxicol. 2021 Feb;128(2):305-314. doi: 10.1111/bcpt.13501. Epub 2020 Oct 15.
The purpose of our study was to develop a simple clinical pre-procedure risk model based on clinical characteristics for the prediction of contrast-induced nephropathy (CIN) and major adverse cardiac events (MACEs) after percutaneous coronary intervention (PCI) in patients with diabetes. A total of 1113 patients with diabetes who underwent PCI with contrast exposure were randomized into a development group (n = 742) and a validation group (n = 371) in a 2:1 ratio. CIN was defined as an increase of either 25% or 0.5 mg/dL (44.2 μmol/L) in serum creatinine within 72 hours after contrast infusion. A simple CIN risk score based on independent predictors was established. Four variables were identified for our risk score model: LVEF < 40%, acute coronary syndrome (ACS), eGFR < 60, and contrast volume > 300 mL. Based on this new CIN risk score, the incidence of CIN had a significant trend with increased predicting score values of 5.9%, 32.9% and 60.0%, corresponding to low-, moderate- and high-risk groups, respectively. The novel risk assessment exhibited moderate discrimination ability for predicting CIN, with an AUC of 0.759 [95% CI 0.668-0.852, P = .001] in the validation cohort. It also had similar prognostic values for one-year follow-up MACE (C-statistic: 0.705 and 0.606 for new risk score and Mehran score, respectively). This novel risk prediction model could be effective for preventing nephropathy in diabetic patients receiving contrast media during surgical procedures.
我们的研究目的是基于临床特征开发一种简单的临床术前风险模型，用于预测糖尿病患者经皮冠状动脉介入治疗（PCI）后对比剂诱导的肾病（CIN）和主要不良心脏事件（MACEs）。共有 1113 名接受对比剂暴露的 PCI 的糖尿病患者被随机分为发展组（n=742）和验证组（n=371），比例为 2:1。CIN 定义为在对比剂输注后 72 小时内血清肌酐升高 25%或 0.5mg/dL（44.2μmol/L）。建立了一个基于独立预测因素的简单 CIN 风险评分。我们的风险评分模型确定了四个变量：LVEF<40%、急性冠脉综合征（ACS）、eGFR<60 和对比剂体积>300mL。根据这个新的 CIN 风险评分，CIN 的发生率与预测评分值呈显著趋势，低、中、高危组的发生率分别为 5.9%、32.9%和 60.0%。新型风险评估对预测 CIN 具有中等的区分能力，验证队列的 AUC 为 0.759[95%CI 0.668-0.852，P=0.001]。它对一年随访的 MACE 也具有类似的预后价值（C 统计量：新风险评分和 Mehran 评分分别为 0.705 和 0.606）。该新型风险预测模型可有效预防接受手术过程中接受对比剂的糖尿病患者发生肾病。
