CHA2DS2-VASC SCORE AS A PREDICTOR FOR CONTRAST-INDUCED NEPHROPATHY IN PATIENT WITH ISCHEMIC HEART DISEASE TREATED WITH PERCUTANEOUS CORONARY INTERVENTION

Abstract

Background: CHA2DS2-VASC risk score (CVRS) is useful in predicting the occurrence of contrast induced nephropathy (CIN) among patients with Ischemic heart disease undergoing percutaneous coronary Intervention. CIN was defined an absolute increase in serum creatinine levels by ≥0.3 mg/dL from baseline, or a relative increase in serum creatinine by ≥50% from baseline, within 48 h after PCI, according to Acute kidney Injury Network (AKIN) definition. Objective: To evaluate CHA2DS2-VASC score as a predictor of contrast induced nephropathy (CIN) in patient with ischemic heart disease undergoing percutaneous coronary intervention (PCI). Patients and Methods: A total of 200 consecutive patients presenting to Cardiology Department, Almogama Alteby Hospital at Tanta city ,during the period from January 2019 to January 2020, diagnosed as IHD and underwent PCI, They were divided into two groups: Group I: Those who developed CIN 48h after PCI (28%) and Group II: Those who did not (72%). CHA2DS2-VASc score (age, sex, diabetes, hypertension, heart failure on admission, previous ischemic event, vascular event) was calculated for each patient. Serum creatinine level and estimated Glomerular Filtration Rate (eGFR) were estimated for all patient before and 48h after PCI. Results: CIN was reported in 56 patients (28%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. The average CVRS in the CIN group was significantly higher than that in non-CIN group. CHADSVASC score cut off value was higher than 3 and the area under the ROC curve was equal to 0.906 which indicating that it is excellent predictor for contrast induced nephropathy cases. The sensitivity, Specificity, positive predictive value and negative predictive values of CHADSVASC score were 80.36, 89.58, 51.5, and 96.0 respectively. Conclusion: The CVRS can be used as a simple pre-procedural predictor of CIN among patients with IHD undergoing PCI.