Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention

Abstract

Contrast-induced acute kidney injury (CI-AKI) is a well-known serious complication of percutaneous coronary intervention (PCI) and may cause increased morbidity and mortality. We aim to identify the predictive value of Global Registry for Acute Coronary Events (GRACE) risk scores for CI-AKI in patients with ST-segment elevation myocardial infarction (STEMI) before primary PCI, allowing pre-procedural decisions regarding prevention therapy for CI-AKI. We enrolled 251 consecutive patients with STEMI undergoing primary PCI. Receiver operating characteristic curves were used to identify the optimal sensitivity for the observed range of GRACE risk scores. CI-AKI was defined as any of the following: absolute increase in serum creatinine (SCr) of ≥ 0.3 or ≥ 0.5 mg/dL within 48-72 h after contrast exposure, or a percentage increase in SCr level of ≥ 50 %. Forty-three patients (17.1 %) developed CI-AKI0.3, 22 (8.8 %) CI-AKI0.5, and 19 (7.6 %) CI-AKI50. The GRACE quartiles were as follows: Q1 (<136), Q2 (136-159), Q3 (159-180), and Q4 (>180). Patients with high GRACE risk scores had higher risk for CI-AKI0.3, 0.5, and 50 (6.6, 6.6, 23.4, 31.7 %, respectively, p < 0.001; 1.6, 1.6, 9.4, 22.2 %, respectively, p < 0.001; and 3.3, 3.2, 9.4, 14.3 %, respectively, p = 0.009). ROC showed that a GRACE risk score >160 was a fair discriminator for CI-AKI0.3, 0.5, and 50 (C statistic = 0.723, 0.788, 0.668, respectively). After adjusting for potential confounding predictors, GRACE risk score >160 remained significantly associated with CI-AKI0.3 or 0.5 (OR 3.84; 95 % CI 1.61-9.17; p = 0.002, or OR 5.54; 95 % CI 1.42-21.66; p = 0.014), and high-sensitivity C-reactive protein (Hs-CRP) >15.5 mg/L was a highly significant predictor of CI-AKI0.3, 0.5, and CI-AKI50. GRACE risk score (>160) and post-procedural Hs-CRP >15.5 mg/L are independent and significant predictors of CI-AKI in patients with STEMI before primary PCI.