Added Value of CHA2DS2-VASc Score to Safe Contrast Volume for Contrast Induced Nephropathy Prediction after Percutaneous Coronary Intervention

Wael Ali khalil; Mohammad Gouda Mohammad; Mohammad Hossam Alshaer; Mohammad Gamal Abd El Mageed

doi:10.30701/ijc.1516

Wael Ali khalil Zagazig university , faculty of medicine,
Mohammad Gouda Mohammad Cardiology department, faculty of medicine, Zagazig university, Egypt
Mohammad Hossam Alshaer Cardiology department, faculty of medicine, Zagazig university, Egypt
Mohammad Gamal Abd El Mageed Cardiology department, faculty of medicine, Zagazig university, Egypt

Keywords: The CHA2DS2-VASc Score; safe contrast volume (Volume/Crl) Contrast Volume to Creatinine Clearance Ratio; Contrast-Induced Nephropathy(CIN)

Abstract

Abstract

Background: The CHA2DS2-VASc score is utilized to order the danger of embolization in atrial fibrillation (AF). Also, it has been assessed the worse clinical scenario in acute coronary syndrome patients, regardless of having AF. The study aim was to use CHA2DS2-VASc score added to the safe contrast volume (Volume /CrCl) for contrast-induced nephropathy (CIN) early prediction post PCI.

Patients and Methods: The study included two hundred fifty nine patients who underwent percutaneous coronary intervention . For each patient, The CHA2DS2-VASc score and Volume /CrCl were evaluated. The patients in our study were divided, according to CIN development into two groups. CIN was identified as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within48 to 72 hours after PCI. Statistical analysis: the receiver operating characteristic analysis was used to detect the best cut off values to predict CIN, and we concluded the predictors of CIN through multivariate logistic regression analysis. Results: There was a positive correlation between Mehran score and CHA2DS2-VASc score. Independent predictors of CIN were Mehran score, Volume/CrCl ratio>3.2 and CHA2DS2-VASc >3, CHF or EF < 40%, hypotension, anemia, primary PCI and weight. If the patient had (CHA2DS2-VASc score>3 or Volume/CrCl >3.2), as a single predictor, we could predict CIN with (sensitivity 96.97 %, 95% CI 0.71 to 0.82).

Conclusion: The CHA2DS2-VASc score and Volume/CrCl ratio are new predictor of CIN, and we can use the CHA2DS2-VASc score , safe contrast volume for early detection of CIN after PCI.

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References

[1] Mehran, R, & Nikolsky, E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney International, 2006; 69:S11-S15.
[2] Abellás-Sequeiros, RA, Raposeiras-Roubin, S, Abu-Assi, E, González-Salvado, V, Iglesias-Álvarez, D, et al. Mehran contrast nephropathy risk score: is it still useful 10 years later? Journal of cardiology, 2016; 67(3): 262-67.
[3] Potpara, Tatjana S, Polovina, Marija M, Licina, Marina M, Marinkovic, Jelena M, Prostran, Milica S, & Lip, Gregory YH. Reliable identification of “truly low” thromboembolic risk in patients initially diagnosed with “lone” atrial fibrillation: the Belgrade atrial fibrillation study. Circulation: Arrhythmia and Electrophysiology, 2012; 5(2): 319-26.
[4] Htyte N, & White CJ. Vascular access for percutaneous interventions and angiography. Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease, 2017; 89.
[5] Olesen JB, Torp-Pedersen C, Hansen ML, & Lip GY. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: a nationwide cohort study. Thrombosis and hemostasis, 2012; 108(06), 1172-79.
[6] Cicek G. & Yıldırım E. CHA2DS2-VASc score predicts contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction, who have undergone primary percutaneous coronary intervention. Kardiologia Polska (Polish Heart Journal), 2018; 76(1), 91-8.
[7] Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. Journal of the American College of Cardiology, 2004; 44(7), 1393-99.
[8] Association, American Diabetes. Standards of medical care in diabetes-2006. Diabetes care, 2006; 29(1): S4.
[9] Subramanian S, Tumlin J, Bapat B, and Zyczynski T. Economic burden of contrast-induced nephropathy: implications for prevention strategies. Journal of medical economics, 2007; 10(2): 119-34.
[10] Ji L, Su X, Qin W, Mi X, Liu F, Tang X, et al. Novel risk score of contrast‐induced nephropathy after percutaneous coronary intervention. Nephrology, 2015; 20(8): 544-51.
[11] Lian D, Liu Y, Liu YH, Li HL, Duan CY, & Yu, DQ. Pre-procedural risk score of contrast-induced nephropathy in elderly patients undergoing elective coronary angiography. International heart journal, 2017; 58(2): 197-204.
[12] Kocas C, Yildiz A, Abaci O, Karaca OS, Firdin, N, Dalgic Y, et al. Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in patients with non-ST-segment elevation acute coronary syndrome. Angiology, 2015; 66(10): 964-68.
[13] Kurtul A, Yarlioglues M, & Duran M. Predictive value of CHA2DS2-VASC score for contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome. The American journal of cardiology, 2017; 119(6): 819-25.
[14] Ursta AA, Kharkov EI, Petrova MM, Ursta OV, Kotikov AR, & Kiselev AN. (Contrast Induced nephropathy in the older age group patients. Advances in gerontology= Uspekhi gerontologii, 30(2) , 2017; 306-10.
[15] Rahman MM, Haque, HS, Banerjee, SK, Ahsan, SA, Rahman, MF, Mahmood, M, et al. Contrast induced nephropathy in diabetic and non-diabetic patients during coronary angiogram and angioplasty. Mymensingh medical journal: MMJ, 2010; 19(3): 372-76.
[16] Heyman, SN, Rosenberger C, Rosen S, & Khamaisi M. Why is diabetes mellitus a risk factor for contrast-induced nephropathy? BioMed research international, 2013; 2013: 123589.
[17] Senoo T, Motohiro M, Kamihata H, & Iwasaka T. Congestive Heart Failure is an Independent Predictor of Contrast-induced Nephropathy in Patients Undergoing Emergency Stent Implantation for Acute Myocardial Infarction. Journal of Cardiac Failure, 2007; 13(6): S53-S54.
[18] Heyman, SN, Reichman J, & Brezis M. Pathophysiology of radiocontrast nephropathy: a role for medullary hypoxia. Investigative radiology, 1999; 34(11), 685.
[19] Li, WH, Li DY, Han F, Xu TD, & Zhang YB, Zhu H. Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. International urology and nephrology, 2013; 45(4), 1065-70.
[20] Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer, FX, & Eckel, RH. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation, 2006; 113(6), 898-918.
[21] Reddan D, Laville M, & Garovic VD. Contrast-induced nephropathy and its prevention: what do we really know from evidence-based findings? Journal of nephrology. 2009: 22: 333-51.
[22] Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan, CY, et al. Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention. Medicine, 2015; 94(12).
[23] Laskey WK, Jenkins C, Selzer F, Marroquin OC, Wilensky RL, Glaser RL, et al. Volume-to-creatinine clearance ratio: a pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. Journal of the American College of Cardiology, 2007; 50(7): 584-90.
[24] Worasuwannarak S, & Pornratanarangsi S. Prediction of contrast-induced nephropathy in diabetic patients undergoing elective cardiac catheterization or PCI: role of volume-to-creatinine clearance ratio and iodine dose-to-creatinine clearance ratio. J Med Assoc Thai, 2010; 93(Suppl 1), S29-S34.