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

Abstract

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.