CHA2 DS2 -VASc score as a predictor for contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Montaser Hamdy ◽  
Hassan Shehata ◽  
Tamer Abuarab
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Significant Relationship ◽  
Predictive Value ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
P Value ◽  
Contrast Induced Nephropathy ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background Contrast induced nephropathy (CIN) is one of the most important complications of PCI. It is a common cause of acute renal failure following invasive procedures, resulting in increased medical resources, longer hospital stay, and higher mortality so it is important to detect early high risk patients for CIN and provide them with preventive measures. In recent years, several studies have demonstrated an association of CHA2DS2-VASc score with cardiovascular prognosis and adverse outcomes in different populations including heart failure, SCAD and ACS beyond the original AF field. The predictive value of the CHA2DS2-VASc score on CIN still remains unclear although all of the components of the CHA2DS2-VASc score are important risk factors for CIN. For this reason, the present study was designed to evaluate the predictive value of preprocedural CHA2DS2-VASc score on the development of CIN in patients with ACS who underwent PCI. Objective To assess the predictive value of the CHA2DS2-VASc Score for contrast induced nephropathy among acute coronary syndrome patients who underwent percutaneous coronary intervention. Material and Methods This study is a prospective study conducted over 300 patients with myocardial infarction who presented at ain shams university hospitals for primary coronary intervention. It took place from February 2019 till September 2019. Results From the study population collected (n = 300), 25.7% of which were females (n = 77), statistically significant relation was found between CIN and CHA2DS2-VASc score. (P value 0.000). A significant relationship existed between CIN and CHA2DS2-VASc score more than 3, and each of: age, female gender, DM, HTN, door to needle time, ACS type (NSTEMI) and killip class above one. (P values 0.000), Patients with previous intervention using contrast (P value = 0.001), anemia (P value 0.014) (p value = 0.000) and contrast volume (p value = 0.002) and number of coronary vessels affected (p value = 0.031). However, non-significant relationship could be concluded between CIN and each of Stroke, TIA and previous thromboembolism (P value = 0.446), ejection fraction (P value = 0.155), Time of procedure (p value = 0.131), culprit vessel (p value = 0.317), type of STEMI (p value = 0.140), Revascularization of culprit vessel (p value = 0.143), TIMI grade (p value = 0.278) and antiplatelet type. (P value 0.934) Conclusion CHA2DS2-VASc score is a simple risk score for bedside, preprocedure CIN risk stratification among ACS patients who underwent primary PCI.

scholarly journals CHA2DS2 -VASc score as a predictor for contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M O N Hamdy Elkholy ◽  
H Shehata ◽  
T Abu Arab
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Significant Relationship ◽  
Predictive Value ◽  
Laboratory Data ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Cutoff Value ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background Contrast induced nephropathy (CIN) is one of the most important complications of PCI, resulting in increased medical resources, longer hospital stay and higher mortality so it is important to detect early high risk patients for CIN and provide them with preventive measures. In recent years, several studies have demonstrated an association of CHA2DS2-VASc score with cardiovascular prognosis and adverse outcomes in different populations including heart failure, SCAD and ACS beyond the original AF field. The predictive value of the CHA2DS2-VASc score on CIN still remains unclear although all of the components of the CHA2DS2-VASc score are important risk factors for CIN. For this reason, the present study was designed to evaluate the predictive value of preprocedural CHA2DS2-VASc score on the development of CIN in patients with ACS who underwent PCI. Objective To assess the predictive value of the CHA2DS2-VASc Score for contrast induced nephropathy among acute coronary syndrome patients who underwent percutaneous coronary intervention. Material and methods This study is a prospective study conducted over 300 patients with myocardial infarction underwent primary coronary intervention. It took place from February 2020 till September 2020. We analyzed patient's demographic data, clinical data, laboratory data, angiographic data and CHADSVASC score and followed up patients daily for 72 hour after PCI for development of CIN then compared these data in CIN versus non CIN patients trying to find out which of these factors can predict occurrence of CIN and find CHADSVASC score cutoff value for prediction of CIN. Results CIN was developed in 89 patients. A significant relationship existed between CIN and female gender, DM, HTN, door to needle time, killip class above one, contrast volume (p<0.000), previous intervention using contrast (p<0.001), anemia (p<0.014), duration of procedure (p<0.074) and number of coronary vessels affected (p<0.031). However, non-significant relationship existed between CIN and Stroke, TIA, previous thromboembolism (p<0.446), ejection fraction (p<0.155), culprit vessel (p<0.317), TIMI grade (p<0.278) and antiplatelet type (p<0.934). Receiver operating characteristic curve analysis showed good predictive value of CHA2DS2-VASc score for CIN (area under the curve 0.801, sensitivity 69.66% and specificity 80.75%). Patients with a CHA2DS2-VASc score cutoff value ≥4 had a higher liability for CIN (p<0.000). Conclusion CHA2DS2-VASc score is a simple bedside risk score for preprocedure CIN risk stratification among ACS patients who underwent primary PCI. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Predictive value of lymphocyte-to-monocyte ratio in patients with contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome

2020 ◽  
Vol 9 (2) ◽  
pp. 123-130
Author(s):  
Irem Karauzum ◽  
Kurtulus Karauzum ◽  
Burak Acar ◽  
Kaan Hanci ◽  
Halil ibrahim Ulas Bildirici ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Roc Analysis ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Monocyte Count ◽  
Contrast Induced Nephropathy ◽  
Coronary Syndrome ◽  
Lymphocyte To Monocyte Ratio ◽  
Percutaneous Coronary

Abstract Background and Objectives Lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation, which is associated with adverse outcomes in cardiovascular diseases. The aim of this study was to evaluate whether admission LMR is associated with contrast-induced nephropathy (CIN) in patients who underwent percutaneous coronary intervention for acute coronary syndrome (ACS). Methods A total of 873 patients were assessed. LMR was calculated via dividing lymphocyte count by monocyte count. Results LMR was significantly lower in the with-CIN group. ROC analysis showed that the LMR ratios <2.52 predicted CIN development with sensitivity of 66.3% and specificity of 55.8%. Multivariate analysis showed that eGFR, admission glucose, and LMR were independent predictors of CIN in patients with ACS. Conclusion LMR is an easily accessible marker and could be used as a predictor of CIN in patients with ACS undergoing percutaneous coronary intervention.

Abstract 320: Healthcare Resource Utilization Among Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Using Prasugrel or Ticagrelor: A Retrospective Database Analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Cliff Molife ◽  
Mark B Effron ◽  
Mitch DeKoven ◽  
Swapna Karkare ◽  
Feride Frech-Tamas ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Coronary Intervention ◽  
Healthcare Resource Utilization ◽  
P Value ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To show that prasugrel (pras) was non-inferior to ticagrelor (ticag) in terms of healthcare resource utilization (HCRU) based upon 30- and 90-day all-cause rehospitalization rates among patients (pts) with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI). Methods: This retrospective study used anonymized hospital data from the IMS Patient-Centric Data Warehouse to identify ACS-PCI pts aged ≥18 years with ≥1 in-hospital claim for pras or ticag between 8/1/11-4/30/13. Three cohorts were predefined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI pts without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). The McNemar’s test was used to evaluate adjusted outcome differences between propensity matched (PM) groups. P-value for non-inferiority (p-NI) test was obtained through a one-sided Z test by comparing log (RR) with log(1.2), a predefined margin. Results: Among 16,098 eligible pts, 13,134 (82%) received pras and 2,964 (18%) received ticag. Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P<0.05). Of the total population, 1,375 (8.54%) and 2,374 (14.75%) were rehospitalized for any reason within 30 and 90 days post discharge, respectively. After PM adjustment, pras was non-inferior to ticag for 30- and 90-day all-cause rehospitalization rates in all 3 cohorts (p-NI < 0.01). Data are summarized in Table 1. All-cause rehospitalization for the label and core cohorts showed non-inferiority and a significantly lower 90-day rehospitalization rate with pras compared with ticag (Table). Conclusions: All-cause rehospitalizations at 30-and 90-days post discharge in ACS-PCI pts were non-inferior with pras vs. ticag in all 3 cohorts. Pras was associated with significantly lower risk for 90-day all-cause rehospitalizations compared with ticag in the label and core cohorts, which are the majority of pts receiving pras. Although there appears to be inherent bias and unmeasured confounders related to use of pras vs. ticag, these data show reductions in HCRU with pras compared with ticag in the real-world setting at 30- and 90-days post-discharge.

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