title: Age, glomerular filtration rate, ejection fraction, and the AGEF score predict contrast-induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  In patients undergoing primary percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), the occurrence of Contrast-Induced Nephropathy (CIN) has a pronounced impact both on morbidity and mortality. We investigated the variables associated with CIN development in 481 consecutive patients with STEMI undergoing primary PCI and evaluated the predictive value of a 3-variable clinical risk score (the AGEF score) based on age, left ventricular ejection fraction (EF), and estimated glomerular filtration rate (eGFR).
  
  
  METHODS
  CIN was defined as an absolute increase in serum creatinine ≥0.5 mg/dL or an increase ≥25% from baseline within 72 hr. AGEF score was calculated by adding 1 point to the Age/EF(%) ratio if the eGFR was <60 mL/min per 1.73 m(2) .
  
  
  RESULTS
  Overall, the incidence of CIN was 5.2%. In-hospital mortality was higher in patients with CIN than in those without (16% Vs 1.3%, P = 0.001). At multivariate analysis age (OR 1.06, P = 0.042), eGFR (OR 0.95, P = 0.001), EF (OR 0.94, P = 0.007) and post-procedural TIMI flow grade (OR 0.43, P = 0.045) were independent predictors of CIN. AGEF score was an accurate (OR 5.19, P < 0.001, AUC 0.88) and calibrated (Hosmer-Lemeshow χ(2) = 10.25, P = 0.25) predictor of CIN.
  
  
  CONCLUSIONS
  Advanced age, depressed EF, and reduced eGFR are independent predictors of CIN development after primary PCI for STEMI. The preprocedural individual patient risk can be clinically assessed with the calculation of the AGEF score, which is based on such readily available parameters.
authors.affiliation: Department of Clinical and Experimental Medicine, Cardiology Section, University of Messina and Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andò
authors.forename: Gaetano
authors.initials: G
authors.lastname: Morabito
authors.forename: Cesare
authors.initials: C
authors.lastname: de Gregorio
authors.forename: Olimpia
authors.initials: O
authors.lastname: Trio
authors.forename: Francesco
authors.initials: F
authors.lastname: Saporito
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003661:Decision Support Techniques; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D015854:Up-Regulation; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: acute myocardial infarction; chronic kidney disease; contrast induced nephropathy; primary percutaneous coronary intervention