Giresun University Faculty of Medicine, Department of Cardiology, Giresun, Turkey.
Eur Rev Med Pharmacol Sci. 2022 Aug;26(16):5793-5801. doi: 10.26355/eurrev_202208_29517.
We aimed to evaluate the association of incomplete revascularization score and the treated coronary artery disease burden with the development of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention. Incomplete revascularization score was expressed by the residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) (rSS) and the treated coronary artery disease burden was expressed by the SYNTAX revascularization index (SRI).
In our study, 604 sequential patients who underwent percutaneous coronary intervention diagnosed with STEMI between January 2018 and December 2021 were included. Patients were categorized into two groups; 'CIN (+)' who developed CIN and 'CIN (-)' who did not develop CIN. Baseline demographic, laboratory, echocardiographic, and angiographic data of the groups were compared. SYNTAX score I and II, rSS, and SRI were calculated. The diagnostic power of these angiographic parameters in the prediction of CIN was evaluated. Predictors for the development of CIN in STEMI patients were investigated.
The mean age of the patients included in our study was 58.7 ± 12.4 years, and 79.9% of them were men. CIN was observed in 17.8% of study patients. The SYNTAX score [17.8 (11.4-24.2) vs. 15.1 (10.1-21.2); p = 0.008] and rSS [8.14 (3.9-116) vs. 4.2 (2.6-8.2); p < 0.001] were higher and SRI [56.2 ± 10.2 vs. 71.1 ± 13.6; p < 0.001] was lower in the CIN (+) group compared to the CIN (-) group. In predicting CIN, rSS was found to have significant diagnostic power at a cut-off value of 5.2, sensitivity of 81% and specificity of 69% [AUC (95% CI) = 0.752 (0.602-0.814); p < 0.001]. In logistic regression analysis, rSS [OR (95% CI) = 1.492 (1.124-1.884); p < 0.001] and SRI [OR (95% CI) = 1.055 (1.027-1.092); p < 0.001] were defined as independent predictors for the development of CIN.
rSS and SRI are associated with CIN in STEMI patients. Although rSS is superior in predicting CIN, both angiographic scorings have significant diagnostic power. rSS and SRI are independent predictors for the development of CIN.
我们旨在评估在接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死（STEMI）患者中，不完全血运重建评分和治疗后的冠状动脉疾病负担与对比剂肾病（CIN）发展之间的关联。不完全血运重建评分用残余 SYNTAX（经皮冠状动脉介入治疗与心脏手术的协同作用）评分（rSS）表示，治疗后的冠状动脉疾病负担用 SYNTAX 血运重建指数（SRI）表示。
在我们的研究中，纳入了 2018 年 1 月至 2021 年 12 月期间接受经皮冠状动脉介入治疗诊断为 STEMI 的 604 例连续患者。患者分为两组：“CIN（+）”组发生了 CIN，“CIN（-）”组未发生 CIN。比较两组的基线人口统计学、实验室、超声心动图和血管造影数据。计算 SYNTAX 评分 I 和 II、rSS 和 SRI。评估这些血管造影参数在预测 CIN 中的诊断能力。研究了 STEMI 患者发生 CIN 的预测因素。
本研究患者的平均年龄为 58.7±12.4 岁，其中 79.9%为男性。研究患者中有 17.8%发生了 CIN。SYNTAX 评分[17.8（11.4-24.2）比 15.1（10.1-21.2）；p=0.008]和 rSS[8.14（3.9-116）比 4.2（2.6-8.2）；p<0.001]更高，SRI[56.2±10.2 比 71.1±13.6；p<0.001]更低在 CIN（+）组与 CIN（-）组之间。在预测 CIN 时，rSS 在截断值为 5.2 时具有显著的诊断能力，灵敏度为 81%，特异性为 69%[AUC（95%CI）=0.752（0.602-0.814）；p<0.001]。在逻辑回归分析中，rSS[OR（95%CI）=1.492（1.124-1.884）；p<0.001]和 SRI[OR（95%CI）=1.055（1.027-1.092）；p<0.001]被定义为 CIN 发展的独立预测因素。
rSS 和 SRI 与 STEMI 患者的 CIN 相关。尽管 rSS 在预测 CIN 方面更具优势，但两种血管造影评分均具有显著的诊断能力。rSS 和 SRI 是 CIN 发展的独立预测因素。
