Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions.

Abstract

This study aimed to compare Mehran Risk Score (MRS) with three well -known scoring systems namely CHA2DS2-VASc score, Canada Acute Coronary Syndrome Risk Score (C-ACS), and Thrombolysis in Myocardial Infarction risk index (TRI) to predict the contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI). CI-AKI is a common complication after primary PCI associated with an adverse prognosis. In this study consecutive patients of primary PCI were included. Patients with chronic kidney diseases, exposure to the contrast medium within the past 7days, and Killip class IV at presentation were excluded. MRS along with three risk scores namely CHA2DS2-VASc, C-ACS, and TRI were calculated for all patients and CI-AKI was defined as either 0.5mg/dL or 25% relative increase in post-procedure serum creatinine. The area under the curve (AUC) curve was reported. Post primary PCI CI-AKI was observed in 63 (9.1%) patients out of 691 patients. The AUC was 0.745 [0.679-0.810] for MRS, 0.725 [0.662-0.788] for CHA2DS2-VASc, 0.671 [0.593-0.749] for C-ACS, and 0.734 [0.674-0.795] for TRI. Sensitivity and specificity were 61.9% [48.8-73.8%] and 76.0% [72.4-79.3%] for MRS≥6.5, 66.7% [53.7-78.0%] and 66.7% [62.9-70.4%] for CHA2DS2-VASc≥2, 52.4% [39.4-65.1%] and 79.9% [76.6-83.0%] for C-ACS≥1, and 87.3% [76.5-94.4%] and 49.2% [45.2-53.2%] for TRI≥16 respectively. The MRS has shown higher discriminating power than CHA2DS2-VASc, C-ACS, and TRI. However, the TRI can be of good value in clinical practice due to its simplicity and high sensitivity in detecting patients at higher risk of CI-AKI after primary PCI.