Abstract
BackgroundContrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study.Methods and resultsPredictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72–0.78; vs. Mehran c-index 0.69, 95% CI 0.66–0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12–0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79–0.91; vs. Mehran c-index 0.75, 95% CI 0.66–0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk.ConclusionIn German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the Mehran model while showing less accurate calibration. Results for the outcome ‘need for dialysis’ were equivocal.Graphic abstract
Highlights
Contrast-induced nephropathy (CIN) is a major adverse event for patients undergoing cardiac catheterization and is associated with increased mortality [1, 2]
For the calculation of the Mehran risk model, 3.8% missing values were imputed for the following variables; hematocrit (n = 11), contrast media volume (n = 108), glomerular filtration rate (n = 15), congestive heart failure (n = 1), systolic blood pressure (n = 493)
For the calculation of the NCDR risk model, 0.12% missing values were imputed for these variables; hemoglobin (n = 11), glomerular filtration rate (n = 15), prior heart failure (n = 1)
Summary
Contrast-induced nephropathy (CIN) is a major adverse event for patients undergoing cardiac catheterization and is associated with increased mortality [1, 2]. Methods and results Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72–0.78; vs Mehran c-index 0.69, 95% CI 0.66–0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12–0.32; p < 0.01) compared to the Mehran model. For the prediction of need for dialysis, NCDR-AKI-D discriminated risk better (c-index 0.85, 95% CI 0.79–0.91; vs Mehran c-index 0.75, 95% CI 0.66–0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk. Conclusion In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrastinduced nephropathy showed superior discrimination compared to the Mehran model while showing less accurate calibration.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
