title: Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) severely impacts patient morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction treated by primary coronary angioplasty, whose renal function is often unknown at the time of contrast exposure.
  
  
  OBJECTIVE
  We sought the incidence and factors predictive of CIN in patients treated by primary coronary angioplasty in our hospital; we also questioned the relevance of Mehran's risk score in this population.
  
  
  METHODS
  We considered all patients admitted for primary coronary angioplasty between January 2010 and December 2011, and included 322 patients with complete data on renal function. CIN was defined as a relative (≥25%) or absolute (≥44 μmol/L) increase in serum creatinine following contrast medium administration. We compared patients with or without CIN, to identify predictive factors, and investigated the effectiveness of Mehran's score using a receiver operating characteristic (ROC) curve, Youden's index and a likelihood ratio test.
  
  
  RESULTS
  The incidence of CIN was 9.1%. A multivariable analysis identified two independent risk factors for CIN: impaired glomerular filtration rate and cardiogenic shock at admission (P<0.05). An elevated Mehran's score was associated with increased incidence of CIN, but statistical analysis revealed this score to have poor sensitivity, especially in high-risk patients. Youden's index was very low and the area under the ROC curve was 0.59 in our population.
  
  
  CONCLUSIONS
  Renal failure and cardiogenic shock at admission were independent predictors of CIN in our acute myocardial infarction population. Mehran's score added little to the discrimination of patients undergoing primary coronary angioplasty, particularly high-risk individuals.
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France; Université François Rabelais de Tours, Tours, France. Electronic address: f.ivanes@chu-tours.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ivanes
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Isorni
authors.affiliation: Université François Rabelais de Tours, Tours, France; Service de Néphrologie, CHRU de Tours, Tours, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France; Université François Rabelais de Tours, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France; Université François Rabelais de Tours, Tours, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Saint Etienne
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France; Université François Rabelais de Tours, Tours, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France; Université François Rabelais de Tours, Tours, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.affiliation: Service de Cardiologie, CHRU de Tours, Tours, France; Université François Rabelais de Tours, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Brunet-Bernard
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003661:Decision Support Techniques; D005260:Female; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: Contrast agent; Infarctus du myocarde; Myocardial infarction; Nephropathy; Néphropathie; Produits de contraste; Risk assessment; Évaluation du niveau de risque