Samir Ahmad, Gabra Wafik, Alhossary Hossam, Bakhoum Sameh
Cardiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Cardiology Department, National Heart Institute, Cairo, Egypt.
Egypt Heart J. 2023 Jun 26;75(1):52. doi: 10.1186/s43044-023-00378-x.
ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) are at increased risk for contrast-induced nephropathy (CIN) than elective PCI procedures. Routine calculation of Mehran's score is limited by its complexity and difficulty to memorize. This study evaluated CHADS-VASc score predictive utility for CIN in STEMI patients before pPCI.
Consecutive 500 acute STEMI patients presenting to two Egyptian pPCI centers were recruited. Exclusion criteria included cardiogenic shock or known severe renal impairment (baseline serum creatinine ≥ 3 mg/dL) or current or previous indication of hemodialysis. CHADSVAS score Mehran's score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV) and CMV/eGFR ratio were collected for all patients. Post-pPCI CIN (defined as 0.5 mg/dL absolute increase or 25% relative increase of serum creatinine from baseline) and predictive accuracy of CHADSVAS and Mehran's scores were evaluated. CIN occurred in 35 (7%) of the study group. Values of CHADSVAS score Mehran's score, baseline eGFR, CMV and CMV/eGFR ratio were significantly higher in those who developed CIN compared to those who did not. CHADSVAS score Mehran's score and CMV/eGFR were found to be independent predictors for CIN (P < 0.001 for all). ROC curve analysis revealed that CHADSVAS ≥ 4 had a superb predictive ability, comparable to Mehran's score, for post-pPCI CIN.
Being practical, easily memorizable and applicable before proceeding to pPCI, routine CHADSVAS score calculation in STEMI patients can effectively predict CIN risk and guide preventive and/or therapeutic interventions.
与择期经皮冠状动脉介入治疗（PCI）相比，接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型心肌梗死（STEMI）患者发生造影剂肾病（CIN）的风险更高。Mehran评分的常规计算因其复杂性和难以记忆而受到限制。本研究评估了CHADS-VASc评分对pPCI术前STEMI患者CIN的预测效用。
招募了连续500例到两个埃及pPCI中心就诊的急性STEMI患者。排除标准包括心源性休克、已知的严重肾功能损害（基线血清肌酐≥3mg/dL）或当前或既往有血液透析指征。收集所有患者的CHADSVAS评分、Mehran评分、基线估计肾小球滤过率（eGFR）、造影剂用量（CMV）和CMV/eGFR比值。评估pPCI术后CIN（定义为血清肌酐较基线绝对增加0.5mg/dL或相对增加25%）以及CHADSVAS和Mehran评分的预测准确性。研究组中有35例（7%）发生CIN。发生CIN的患者的CHADSVAS评分、Mehran评分、基线eGFR、CMV和CMV/eGFR比值显著高于未发生CIN的患者。发现CHADSVAS评分、Mehran评分和CMV/eGFR是CIN的独立预测因素（所有P均<0.001）。ROC曲线分析显示，CHADSVAS≥4对pPCI术后CIN具有与Mehran评分相当的出色预测能力。
STEMI患者术前常规计算CHADSVAS评分实用、易于记忆且适用，可有效预测CIN风险并指导预防和/或治疗干预。
