title: Relation of the severity of contrast induced nephropathy to SYNTAX score and long term prognosis in patients treated with primary percutaneous coronary intervention.
abstract: BACKGROUND
  SYNTAX score (SXscore) has been developed to assess the severity and complexity of coronary artery disease. The aim of this study was to evaluate whether baseline SXscore was associated with contrast induced nephropathy (CIN) after primary percutaneous coronary intervention (p-PCI) in patients with ST-elevation myocardial infarction (STEMI). Secondarily we aimed to investigate the relation of the severity of CIN to long term prognosis.
  
  
  METHODS
  We retrospectively enrolled 1893 patients with STEMI treated by p-PCI. We prospectively followed up the patients for a mean duration of 45 months. The patients were grouped according to the development of no nephropathy (grade 0, n: 1634), mild nephropathy (grade 1, n: 153) or severe nephropathy (grade 2, n: 106).
  
  
  RESULTS
  SXscore was significantly higher (19.4±5.9 vs 15.6±4.8, p<0.001) in patients with CIN (grades 1 and 2) compared to those without CIN. SXscore was higher in patients with grade 2 CIN compared to those with grade 1 CIN (18.5±5.7 vs 20.7±5.9, p<0.001). In the multivariate analysis, SXscore was identified as an independent predictor of CIN (for one unit increment, OR: 1.06, 95% CI: 1.01-1.14, p=0.006). At long-term follow-up, death (p<0.001), stroke (p=0.006), reinfarction (p=0.024) and permanent HD requirement (p<0.001) were most frequent in grade 2 nephropathy group. HD was associated with very high in-hospital (60%) and long-term (83.3%) mortality rates.
  
  
  CONCLUSIONS
  SXscore is an independent predictor of development and severity of CIN after p-PCI. CIN is associated with poor prognosis during both early and late postinfarction period.
authors.affiliation: Fatih Medikal Park Hospital, Department of Cardiology, Istanbul, Turkey. Electronic address: voduncu@yahoo.com.
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Can Yücel
authors.initials: CY
authors.lastname: Karabay
authors.forename: Cihan
authors.initials: C
authors.lastname: Şengül
authors.forename: Ali Cevat
authors.initials: AC
authors.lastname: Tanalp
authors.forename: Hakan
authors.initials: H
authors.lastname: Fotbolcu
authors.forename: Olcay
authors.initials: O
authors.lastname: Özveren
authors.forename: Atila
authors.initials: A
authors.lastname: Bitigen
authors.forename: Selçuk
authors.initials: S
authors.lastname: Pala
authors.forename: Cevat
authors.initials: C
authors.lastname: Kırma
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Contrast induced nephropathy; Primary angioplasty; Prognosis; Syntax score