Combined Value of Contrast-Induced Nephropathy and the CHA2DS2-VASc Score for Predicting Mortality in Patients with Acute Coronary Syndrome Who Were Undergoing Percutaneous Coronary Intervention
Eyüp Avcı, Didar Elif Akgün, Onursal Buğra, Ahmet Dolapoğlu, Aykan Çeli̇k, Tuncay Kırış
Keywords: Acute coronary syndrome, mortality, risk score, renal function
Introduction: Both contrast-induced nephropathy (CIN) and CHA2DS2-VASc score have predictive value for mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), whereas the prognostic significance CHA2DS2-VASc of risk score combined with CIN remains unclear. This study was designed to explore the combined value of CIN and CHA2DS2-VASc score for predicting long-term mortality in these patients. Patients and Methods: This retrospective study included 1058 consecutive patients with ACS who were treated with PCI. CIN was defined as a serum creatinine increase ≥ 0.5 mg/dL or ≥ 25% within 48-72 hours after contrast exposure. The patients were divided into two groups, as survivors or nonsurvivors. Results: The CHA2DS2-VASc score and CIN were independently predictive for all-cause mortality (HR: 1.444, 95% CI: 1.327-1.572, p< 0.001; HR: 1.850, 95% CI: 1.298-2.637, p= 0.001, respectively). Also, multivessel diseases, Killip ≥ 2, beta blockers, and ACE/ARB use at follow-up were independently risk factors for all-cause mortality. Adding CIN on top of the CHA2DS2-VASc score yielded superior risk-predictive capacity beyond CHA2DS2-VASc score alone [AUC: 0.735 (0.701-0.769)], which is shown by improved AUC [AUC: 0.754 (0.720-0.787, difference p= 0.0149)] as well as net reclassification improvement (NRI 28.5%, p< 0.001) and integrated discrimination improvement (IDI 0.021, p< 0.001). Conclusion: Our study demonstrated that combining the predictive value of CIN and the CHA2DS2-VASc score yielded a more accurate predictive value for long-term mortality in ACS patients who underwent PCI as compared to the CHA2DS2-VASc score alone.