Aims Contrast-induced nephropathy (CIN) is an important complication of iodinated contrast media administration. In patients undergoing primary percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), the occurrence of CIN has a pronounced impact both on morbidity and mortality. We investigated the variables associated with the development of CIN in patients with STEMI undergoing primary PCI and to evaluate the predictive value of a 3-variable clinical risk score (the AGEF score) based on age, left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR). Methods and results 481 consecutive patients with STEMI who were undergoing primary PCI were prospectively enrolled. CIN was defined as an absolute increase in serum creatinine ≥0.5 mg/dL or an increase ≥25% from baseline within 72 hours after the administration of contrast medium. AGEF score was calculated by adding 1 point to the Age/EF(%) ratio if the eGFR was <60 mL/min per 1.73 m2. The incidence of CIN was 5.2%. In-hospital mortality was higher among patients with CIN than those without CIN (16% Vs 1.3%, p=0.001). At multivariable analysis, age (OR 1.08, p=0.038), eGFR (OR 0.95, p=0.002), LVEF (OR 0.94, p=0.033) and post-procedural TIMI flow grade (OR 0.30, p=0.01) were independent predictors of CIN. AGEF score was an accurate (OR 5.19, 95% CI 3.13-8.62, p<0.0001, AUC 0.88) and well calibrated (Hosmer-Lemeshow χ2=6.24, p=0.62) predictor of CIN. Conclusions Advanced age, depressed LVEF and reduced eGFR are independent predictors of CIN development after primary PCI for STEMI. In our model, the pre-procedural individual patient risk can be clinically assessed with the calculation of the AGEF score, which is based on such readily available parameters, by solving this exponential equation: Risk= e AGEF score x 1.65–6.26 / (1+e AGEF score x 1.65–6.26).
Age, glomerular filtration rate, ejection fraction, and the AGEF score predict contrast-induced nephropathy in patients with STEMI undergoing primary PCI.
ANDO', Giuseppe;MORABITO, GAETANO;DE GREGORIO, Cesare;TRIO, OLIMPIA;ORETO, Giuseppe
2012-01-01
Abstract
Aims Contrast-induced nephropathy (CIN) is an important complication of iodinated contrast media administration. In patients undergoing primary percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), the occurrence of CIN has a pronounced impact both on morbidity and mortality. We investigated the variables associated with the development of CIN in patients with STEMI undergoing primary PCI and to evaluate the predictive value of a 3-variable clinical risk score (the AGEF score) based on age, left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR). Methods and results 481 consecutive patients with STEMI who were undergoing primary PCI were prospectively enrolled. CIN was defined as an absolute increase in serum creatinine ≥0.5 mg/dL or an increase ≥25% from baseline within 72 hours after the administration of contrast medium. AGEF score was calculated by adding 1 point to the Age/EF(%) ratio if the eGFR was <60 mL/min per 1.73 m2. The incidence of CIN was 5.2%. In-hospital mortality was higher among patients with CIN than those without CIN (16% Vs 1.3%, p=0.001). At multivariable analysis, age (OR 1.08, p=0.038), eGFR (OR 0.95, p=0.002), LVEF (OR 0.94, p=0.033) and post-procedural TIMI flow grade (OR 0.30, p=0.01) were independent predictors of CIN. AGEF score was an accurate (OR 5.19, 95% CI 3.13-8.62, p<0.0001, AUC 0.88) and well calibrated (Hosmer-Lemeshow χ2=6.24, p=0.62) predictor of CIN. Conclusions Advanced age, depressed LVEF and reduced eGFR are independent predictors of CIN development after primary PCI for STEMI. In our model, the pre-procedural individual patient risk can be clinically assessed with the calculation of the AGEF score, which is based on such readily available parameters, by solving this exponential equation: Risk= e AGEF score x 1.65–6.26 / (1+e AGEF score x 1.65–6.26).Pubblicazioni consigliate
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