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J Am Coll Cardiol, 2004; 44:1393-1399, doi:10.1016/j.jacc.2004.06.068
© 2004 by the American College of Cardiology Foundation
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INTERVENTIONAL CARDIOLOGY

A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention

Development and initial validation

Roxana Mehran, MD*,{dagger}, Eve D. Aymong, MD, MSc, FACC*, Eugenia Nikolsky, MD, PhD*,{dagger}, Zoran Lasic, MD, FACC*, Ioannis Iakovou, MD*, Martin Fahy, MSc*, Gary S. Mintz, MD, FACC*, Alexandra J. Lansky, MD, FACC*,{dagger}, Jeffrey W. Moses, MD, FACC*,{dagger}, Gregg W. Stone, MD, FACC*,{dagger}, Martin B. Leon, MD, FACC*,{dagger} and George Dangas, MD, PhD, FACC*,{dagger},*

* Cardiovascular Research Foundation
{dagger} Columbia University Medical Center, New York, New York

Manuscript received February 4, 2004; revised manuscript received June 14, 2004, accepted June 22, 2004.

* Reprint requests and correspondence: Dr. George Dangas, Columbia University Medical Center, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022 (Email: gdangas{at}crf.org).

OBJECTIVES: We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).

BACKGROUND: Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown.

METHODS: A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value <0.0001. Based on the odds ratio, eight identified variables (hypotension, intra-aortic balloon pump, congestive heart failure, chronic kidney disease, diabetes, age >75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient.

RESULTS: The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [≤5] and high [≥16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively).

CONCLUSIONS: The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.

Abbreviations and Acronyms
  CIN = contrast-induced nephropathy
  eGFR = estimated glomerular filtration rate
  IABP = intra-aortic balloon pump
  OR = odds ratio
  PCI = percutaneous coronary intervention




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