title: Validation of a new risk score to predict contrast-induced nephropathy after percutaneous coronary intervention.
abstract: Contrast-induced nephropathy (CIN) is a frequent, potentially lethal complication of percutaneous coronary interventions (PCIs). We prospectively validated the diagnostic performance of a simple CIN risk score in a large multicenter international cohort of patients who underwent PCI. About 2,882 consecutive patients treated with elective or urgent PCI were enrolled. A simple CIN risk score was calculated for all patients by allocating points according to a prespecified scale (pre-existing renal disease = 2; metformin use = 2; previous PCI = 1; peripheral arterial disease = 2; and injected volume of contrast medium ≥300 ml = 1). CIN was defined as an increase, compared with baseline, of serum creatinine by ≥25%, or by ≥0.5 mg/dl, 48 hours after PCI. CIN occurred in 15.7% of the study population. The predictive accuracy of the CIN risk score was good (c-statistic 0.741, 95% confidence interval 0.713 to 0.769). Receiver-operating characteristic analysis identified a score of ≥3 as having the best diagnostic accuracy. Examination of the performance of the proposed risk score using different definitions of CIN yielded a robust predictive ability. The score exhibited good discrimination (area under the curve ≥0.700) across all predefined subgroups of the study population. Compared with 2 previously published risk scores for CIN, our score demonstrated higher discriminative ability and resulted in a net reclassification improvement and an integrated discrimination improvement (p <0.001). In conclusion, the new risk score can easily be applied in the setting of urgent or elective PCI, allows for robust risk assessment and offers the potential to improve the peri-interventional management of patients at risk for CIN.
authors.affiliation: Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: dtziakas@med.duth.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tziakas
authors.affiliation: Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Chalikias
authors.affiliation: Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stakos
authors.affiliation: Cardiology Department, Medical School, Trakya University, Edirne, Turkey.
authors.forename: Armagan
authors.initials: A
authors.lastname: Altun
authors.affiliation: Cardiology Department, Medical School, Trakya University, Edirne, Turkey.
authors.forename: Nasir
authors.initials: N
authors.lastname: Sivri
authors.affiliation: Department of Cardiology, Middle East Hospital, Mersin, Turkey; Department of Cardiology, International Medical Center, Mersin, Turkey.
authors.forename: Ertan
authors.initials: E
authors.lastname: Yetkin
authors.affiliation: Department of Cardiology, Middle East Hospital, Mersin, Turkey; Department of Cardiology, International Medical Center, Mersin, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gur
authors.affiliation: Department of Cardiology, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Stankovic
authors.affiliation: Department of Cardiology, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Mehmedbegovic
authors.affiliation: Second Department of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
authors.affiliation: Second Department of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Chatzikyriakou
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Garcia-Moll
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: Department of Nephrology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Ploumis
authors.initials: P
authors.lastname: Passadakis
authors.affiliation: Department of Nephrology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Thodis
authors.affiliation: Department of Nephrology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vargemezis
authors.affiliation: Cardiovascular Sciences Research Centre, University of London, London, United Kingdom.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.affiliation: Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D003404:Creatinine