Vol 29, No 4 (2023)
Research paper
Published online: 2023-12-21
Comparing two risk scores for predictive ability of contrast-induced nephropathy development in patients presenting with chronic coronary syndrome
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DOI: 10.5603/aa.95095
Acta Angiologica 2023;29(4):133-140.
Abstract
Introduction: This study aimed to investigate the roles of ATRIA and CHA2DS2-VASc scores in predicting contrast-induced nephropathy (CIN) development risk in patients presenting with chronic coronary syndromes (CCS) and undergoing elective percutaneous coronary intervention (PCI).
Material and methods: Patients who underwent coronary angiography due to diagnosis of CCS and decided to be treated with PCI between 2018 and 2020 were included in this retrospective single-centre study.
Results: A total of 447 patients were included. DM [p < 0.0001, β: 0.263, OR (95%CI): 0.187–0.459], CHF [p = 0.035, β: 0.384, OR (95%CI): 0.158–0.934], the volume of CA [p = 0.020, β: 0.145, OR (95%CI): 0.112–0.393], ATRIA [p = 0.001, β: 3.453, OR (95%CI): 1.132–6.148] and CHA2DS2-VASc [p < 0.0001, β: 3.120, OR (95%CI): 1.925–5.056] scores were found as independent risk factors associated with CIN development. The AUC for the ATRIA score was 0.779 [%95CI: 0.717–0.842]. A cutoff value of 4.5 for the ATRIA score was associated with 74.1% sensitivity and 67.3% specificity in the prediction of CIN development. Moreover, the AUC for the CHA2DS2-VASc score was 0.869 [%95CI: 0.825–0.912]. A cutoff value of 3.5 for the CHA2DS2-VASc score was associated with 81.5% sensitivity and 76.1% specificity in the prediction of CIN development.
Conclusion: ATRIA and CHA2DS2-VASc scores may be used as a marker of CIN development in CCS patients
who underwent elective PCI and both scores may be used to define patients under risk in a practical way.
Keywords: contrast-induced nephropathyCINATRIACHA2DS2-VASc
References
- Weisbord SD, Palevsky PM. Radiocontrast-induced acute renal failure. J Intensive Care Med. 2005; 20(2): 63–75.
- Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int. 2005; 68(1): 14–22.
- Detrenis S, Meschi M, Musini S, et al. Lights and shadows on the pathogenesis of contrast-induced nephropathy: state of the art. Nephrol Dial Transplant. 2005; 20(8): 1542–1550.
- Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006(100): S11–S15.
- Iakovou I, Dangas G, Mehran R, et al. Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention. J Invasive Cardiol. 2003; 15(1): 18–22.
- Wu MY, Lo WC, Wu YC, et al. The Incidence of Contrast-Induced Nephropathy and the Need of Dialysis in Patients Receiving Angiography: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022; 9: 862534.
- Yang Yi, George KC, Luo R, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol. 2018; 19(1): 374.
- Nijssen EC, Rennenberg RJ, Nelemans PJ, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial]. Ned Tijdschr Geneeskd. 2018; 161: D1734.
- Jurado-Román A, Hernández-Hernández F, García-Tejada J, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol. 2015; 115(9): 1174–1178.
- Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285(22): 2864–2870.
- Lip GYH, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010; 137(2): 263–272.
- Singer DE, Chang Y, Borowsky LH, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc. 2013; 2(3): e000250.
- Hioki H, Miura T, Miyashita Y, et al. Risk stratification using the CHADS-VASc score in patients with coronary heart disease undergoing percutaneous coronary intervention; sub-analysis of SHINANO registry. Int J Cardiol Heart Vasc. 2015; 7: 76–81.
- Ma X, Shao Q, Dong L, et al. Prognostic value of CHADS2 and CHA2DS2-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Medicine (Baltimore). 2020; 99(30): e21321.
- Chua SK, Lo HM, Chiu CZ, et al. Use of CHADS₂ and CHA₂DS₂-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014; 9(10): e111167.
- Zhu W, Wu Y, Zhou Y, et al. CHA2DS2-VASc and ATRIA Scores and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction. Cardiovasc Drugs Ther. 2020; 34(6): 763–772.
- Aksoy F, Bagcı A. Predictive value of ATRIA risk score for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Rev Assoc Med Bras (1992). 2019; 65(11): 1384–1390.
- Chou RH, Huang PH, Hsu CY, et al. CHADS2 score predicts risk of contrast-induced nephropathy in stable coronary artery disease patients undergoing percutaneous coronary interventions. J Formos Med Assoc. 2016; 115(7): 501–509.
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. G Ital Cardiol (Rome). 2022; 23(4): e1–e127.
- Whelton PK, Carey RM, Aronow WS, et al. Dennison Himmelfarb C, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71(19): e127–e248.
- Easton JD, Saver JL, Albers GW, et al. American Heart Association, American Stroke Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Interdisciplinary Council on Peripheral Vascular Disease. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009; 40(6): 2276–2293.
- Petersmann A, Müller-Wieland D, Müller UA, et al. Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol Diabetes. 2019; 127(S 01): S1–S7.
- Aboyans V, Ricco JB, Bartelink MLEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Rev Esp Cardiol (Engl Ed). 2018; 71(2): 111.
- Basile DP, Yoder MC. Renal endothelial dysfunction in acute kidney ischemia reperfusion injury. Cardiovasc Hematol Disord Drug Targets. 2014; 14(1): 3–14.
- Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004; 44(7): 1393–1399.
- Centola M, Lucreziotti S, Salerno-Uriarte D, et al. Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction. Int J Cardiol. 2014; 174(1): 37–42.
- Rear R, Bell RM, Hausenloy DJ. Contrast-induced nephropathy following angiography and cardiac interventions. Heart. 2016; 102(8): 638–648.
- Gupta RK, Kapoor A, Tewari S, et al. Captopril for prevention of contrast-induced nephropathy in diabetic patients: a randomised study. Indian Heart J. 1999; 51(5): 521–526.
- Umruddin Z, Moe K, Superdock K. ACE inhibitor or angiotensin II receptor blocker use is a risk factor for contrast-induced nephropathy. J Nephrol. 2012; 25(5): 776–781.
- Kiski D, Stepper W, Brand E, et al. Impact of renin-angiotensin-aldosterone blockade by angiotensin-converting enzyme inhibitors or AT-1 blockers on frequency of contrast medium-induced nephropathy: a post-hoc analysis from the Dialysis-versus-Diuresis (DVD) trial. Nephrol Dial Transplant. 2010; 25(3): 759–764.
- Yildirim A, Kucukosmanoglu M, Yavuz F, et al. Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity. Angiology. 2021; 72(7): 664–672.
- Aksoy F, Uysal D. A Simple Risk Scoring Systems to evaluate the presence of aneurysm and one-year mortality in patients with abdominal aortic aneurysm using CHA2DS2-VASc and ATRIA. Rev Assoc Med Bras (1992). 2021; 67(1): 101–106.
- Abacioglu OO, Yildirim A, Koyunsever NY, et al. The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2022; 73(1): 79–84.
- Çetinkal G, Koçaş C, Balaban Koçaş B, et al. Comparative performance of AnTicoagulation and Risk factors In Atrial fibrillation and Global Registry of Acute Coronary Events risk scores in predicting long-term adverse events in patients with acute myocardial infarction. Anatol J Cardiol. 2018; 20(2): 77–84.
- Dönmez E, Özcan S, İnce O, et al. Predictive Value of CHA2DS2-VASc Score in Patients with Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction. Turk Kardiyol Dern Ars. 2023; 51(2): 97–103.
- Elmore JB, Mehanna E, Parikh SA, et al. Restenosis of the Coronary Arteries: Past, Present, Future Directions. Interv Cardiol Clin. 2016; 5(3): 281–293.