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

Abstract

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.