VALIDITY OF MEHRAN RISK SCORE FOR PREDICTING CONTRAST INDUCED NEPHROPATHY IN MODERN PRIMARY PERCUTANEOUS CORONARY INTERVENTIONS ERA | [Pakistan Heart Journal • 2022]

Author(s):

1. Rajesh Kumar: National Institute of Cardiovascular Diseases, Karachi, Pakistan

2. Tarique Ahmed: National Institute of Cardiovascular Diseases, Karachi, Pakistan

3. Shahzad Khatti: National Institute of Cardiovascular Diseases, Karachi, Pakistan

4. Aziz-ur Rehman Memon: National Institute of Cardiovascular Diseases, Karachi, Pakistan

5. Naveed Ahmed Shaikh: National Institute of Cardiovascular Diseases, Karachi, Pakistan

6. Fawad Farooq: National Institute of Cardiovascular Diseases, Karachi, Pakistan

7. Zille Huma: National Institute of Cardiovascular Diseases, Karachi, Pakistan

8. Sabir Hussain: National Institute of Cardiovascular Diseases, Karachi, Pakistan

9. Jawaid Akbar Sial: National Institute of Cardiovascular Diseases, Karachi, Pakistan

10. Tahir Saghir: National Institute of Cardiovascular Diseases, Karachi, Pakistan

Abstract:

Objectives: Contrast induced nephropathy (CIN) is a common complication and found to be associated with increased morbidity and mortality after primary percutaneous coronary intervention (PCI). The objective of this study was to validate the Mehran Risk Score (MRS) for the risk stratification of CIN in patients undergone primary PCI. Methodology: A cohort of consecutive patients undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patents history of any PCI, and chronic kidney diseases were excluded from this study. MRS was calculated at baseline and post procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. Results: A total of 547 patients were included, of which 79.3%(434) were male. CIN after primary PCI was observed in 62(11.3%) patients. The area under the curve (AUC) for the MRS was 0.712 [0.641 to 0.783]. Cut-off value of =6.5 had sensitivity of 61.3% [48.1%-73.4%] with positive predictive value of 21.2% [17.5%-25.6%] and specificity of 70.9% [66.7%-74.9%] with negative predictive value of 93.5% [91.3%-95.2%]. MRS =6.5 was found to be an independent predictor on multivariable analysis with adjusted odds ratios (OR) of 3.86 [2.23 6.68] along with multi-vessel diseases with OR of 2.31 [1.27-4.19]. Conclusion: MRS has shown to have a good discriminating power. However low positive predictive value of the optimal cutoff value of =6.5 for prediction of CIN suggests need of modification to the MRS to improve its clinical utility in the modern era of primary PCI.

Page(s): 73-78

DOI: DOI not available

Published: Journal: Pakistan Heart Journal, Volume: 55, Issue: 1, Year: 2022

Keywords:

Contrast induced nephropathy , primary percutaneous coronary intervention , Mehran risk score

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