INTERVENTIONAL CARDIOLOGY
A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention
Development and initial validation
Roxana Mehran, MD*, ,
Eve D. Aymong, MD, MSc, FACC*,
Eugenia Nikolsky, MD, PhD*,,
Zoran Lasic, MD, FACC*,
Ioannis Iakovou, MD*,
Martin Fahy, MSc*,
Gary S. Mintz, MD, FACC*,
Alexandra J. Lansky, MD, FACC*,,
Jeffrey W. Moses, MD, FACC*,,
Gregg W. Stone, MD, FACC*,,
Martin B. Leon, MD, FACC*, and
George Dangas, MD, PhD, FACC*,,*
* Cardiovascular Research Foundation
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.
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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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