Predictive significance of the neutrophil percentage-to-albumin ratio in post-percutaneous coronary intervention contrast-induced nephropathy among type 2 diabetes mellitus patients with chronic coronary syndrome.

Abstract Introduction Contrast-induced nephropathy (CIN) remains a common complication, affecting 5–10% of patients undergoing percutaneous coronary intervention (PCI). While its association with pre-existing renal disease and excessive use of iodinated contrast has been extensively studied, other precipitating factors should also be identified to enable the prompt adoption of preventive strategies. This study aims to identify the main predicting factors of CIN and develop a score that could be used to define preventive strategies. Methods A retrospective study was designed, including all patients who underwent urgent or elective PCI between January 1, 2019, and May 31, 2024, with a creatinine clearance ≥60 ml/min (calculated with the Cockroft-Gault formula) and serum creatinine ≤1.2 mg/dL. CIN was defined as an increase of ≥0.5 mg/dL in serum creatinine or ≥0.25% increase from basal levels within the first 48 hours post-procedure. Comorbidities and concomitant medications were studied in a multivariate analysis and a score named ADAFH was developed consisting in the cumulative impact of fibrinolysis (p=0.017 - 1 point), Heart Failure (p= 0.02, 1 point), Anaemia (p= 0.025, 2 points), Diabetes (p=0.007, 2 points) and the protective Alopurinol role (p=0.04), -1 point). High-risk patients were considered with a score equal or above 3. Then we studied its impact on CIN development using binary logistic regression and compared it with validated association such as volume of iodinated contrast/creatinine clearance ratio (Vc/Clcr) > 4. Results 487 patients were included, 59.1% (n=289) were men, with a mean age of 66.6 ±10 years, 31.0% (n=151) diabetic, 8,2% (n=40) who underwent fibrinolysis before PCI, 14.6% (n=71) currently under Allopurinol, 23.4% (n=114) with Hb < 13 g/dl and 8.0% (n=39) with history of heart failure. Mean ClCr was 91.92 ml/min/1.73m² ± 28.26 and an average dose of iodinated contrast used of 208,61 ± 2.48 ml. 10.5% (n=51) patients developed CIN. Mean ADAFH score was 1.11 ± 2.1, with 13.3% (n=65) patients classified in the high-risk group for diabetic nephropathy according to the ADAFH score. We found that CIN was more common in patients who scored equal or above 3 in the ADAFH score (52.9% vs 10.6%: χ² = 64.39 p=0.001). In binary logistic regression, the ADAPH score seemed to be an independent predictor of CIN (OR: 9.538, 95% CI: 5.085–9.538, p = 0.001). ROC curve analysis demonstrated an acceptable capacity of predicting CIN, better than the Vc/Clcr > 4 (AUC 0.81 vs 0.66; p=0.04) (Figure 1). Conclusion This study highlights the likely impact of the ADAFH score and its’ variables on the development of CIN, further demonstrating a real risk of this complication even in patients with good renal function at admission, with an acceptable performance in predicting CIN. It also emphasizes the need to adopt preventive strategies, particularly in patients that despite its apparently normal creatinine clearance, might be in greater risk for CIN.

Contrast-induced nephropathy (CIN) remains a frequent and clinically relevant complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study evaluated the predictive performance of inflammation-based indices for CIN development, with a focus on the inflammatory prognostic index (IPI). STEMI patients (n = 563) were retrospectively analyzed. CIN developed in 85 patients (15.1%). Admission IPI values were significantly higher in patients who developed CIN compared with those without CIN (10.9 [7.6-16.2] vs 4.8 [3.1-7.9], P < .001). In multivariate logistic regression analysis, IPI remained independently associated with CIN (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.61, P = .013), together with advanced age, higher blood urea nitrogen levels, reduced left ventricular ejection fraction, history of stroke, and the occurrence of no-reflow. Receiver operating characteristic analysis demonstrated superior discriminative performance for IPI (area under the curve [AUC] 0.826, 95% CI 0.783-0.869) compared with neutrophil-to-lymphocyte ratio (NLR; AUC 0.691), C-reactive protein-to-albumin ratio (CAR; AUC 0.712), and systemic immune inflammation index (SII; AUC 0.704). An admission IPI cutoff value of 8.35 predicted CIN with 82.4% sensitivity and 65.9% specificity. IPI demonstrates superior discriminative performance compared with CAR, NLR, and SII for predicting CIN in STEMI patients undergoing pPCI.

Saline optical coherence tomography in percutaneous coronary intervention: Practical considerations and technical guidance.

Background: Contrast-enhanced imaging is important for diagnosing critical conditions in hospitalized patients. Iodinated contrast media are important for diagnostic imaging, but it also carry risks of adverse reactions. Most studies examined the outpatients, but we focused on hospitalized patients who are already suffering from some disease or illness and staying in the hospital. These patients are already having health problems and need urgent scan. We should study on how risky contrast can be for already suffering patients specifically. Objective: To find out how commonly adverse reactions can happen in hospitalized patients who are getting contrast for imaging and to see if kidney disease can make these contrast reactions worse. Methodology: We studied 114 patients who underwent contrast imaging. We noted the basics which includes age, sex, and the conditions or diseases they had. Then followed up who reacted and how severely reacted to contrast. Furthermore, we added crosstabs to check if kidney disease and reactions are aligned. Results: Mostly older patients which include 55.3% were aged 50–65 years, 41.2% were aged 66–80 years. 52.6% were male and 47.4% were female. Hypertension was present in 43.9%, kidney disease in 27.2%, cancer in 7.9%. Overall reaction rate was 29.8%, 70.2% had no reaction, 21.1% showed mild, 6.1% showed moderate, 2.6% showed severe reaction. The critical finding was all severe reactions occurred exclusively in kidney disease patients 9.7% of that subgroup versus 0% with healthy kidneys. Patients with kidney disease showed higher reaction rates: 64.5% reacted while only 16.9% of those with normal kidneys. Cancer clustered unexpectedly in kidney patients (25.8% versus 1.2%). Conclusion: This study gives us the hospital patient perspective that was not looked at before. Kidney disease is the reason why some hospitalized patients have really bad reactions to contrast. So, it is really important that we check the kidneys of all inpatients and take care with the people who have kidney disease to prevent any adverse reaction. Another reason is that the patients are already having medications which are affecting their kidneys.

Older adults constitute a growing proportion of patients presenting with acute coronary syndrome (ACS); optimal management remains uncertain due to comorbidities, frailty, procedure-related complications. This study aimed to identify prognostic determinants and to evaluate the impact of invasive management strategies on short- and long-term outcomes in elderly patients with ACS. We retrospectively analyzed consecutive ACS patients aged ≥ 75 years who underwent coronary angiography. Frailty was assessed within the first 48 h of admission using the Rockwood Clinical Frailty Scale (CFS). Sex-related differences, frailty, treatment strategies (percutaneous coronary intervention [PCI] vs. conservative/medical therapy), predictors of short- and long-term outcomes were assessed. The primary endpoint was all-cause mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs). A total of 627 patients were included (46% women), with non-ST-elevation ACS (NSTE-ACS) as the predominant presentation (66.8%). Patients presenting with ST-elevation myocardial infarction (STEMI) experienced significantly higher in-hospital mortality (19.7% vs.5.7%) and MACCEs rates (50.5% vs. 22%; both p < 0.001) compared with those with NSTE-ACS. In-hospital and 1-year mortality did not differ by sex. Shock, frailty, contrast-induced nephropathy, peak troponin levels as independent predictors of in-hospital mortality, whereas frailty, reduced left ventricular ejection fraction, peak troponin independently predicted long-term mortality. Among patients with NSTE-ACS, PCI was associated with lower in-hospital mortality (3.5% vs. 8.4%; p = 0.040) but higher rates of in-hospital and long-term adverse events, without a significant reduction in 1-year mortality. Frailty is a dominant determinant of both short- and long-term mortality and should be systematically incorporated into early risk stratification. A selective, frailty-guided invasive strategy may improve early survival whereas routine intervention appears unjustified given the lack of long-term benefit and increased complication risk.

Timely diagnosis of mesenteric vascular diseases, especially acute mesenteric ischemia (AMI) due to embolism in the superior mesenteric artery (SMA), is crucial for effective intervention. Dual-energy computed tomography angiography (DE-CTA) is a key diagnostic tool; however, concerns about contrast-induced nephropathy and radiation exposure persist. This study assesses the diagnostic performance of DE-CTA for detecting mesenteric vascular diseases and compares the effectiveness of image reconstruction algorithms, specifically ASIR-V and DLIR, in enhancing image quality while minimizing the risks associated with contrast agents and radiation exposure. DE-CTA with virtual monoenergetic imaging (VMI) at 40keV was performed on 50 patients. Image quality was evaluated using contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and standard deviation (SD). The performance of DLIR and ASIR-V algorithms was compared, with an emphasis on minimizing radiation dose and contrast agent use through optimized low-dose protocols. DLIR-H significantly outperformed both ASIR-V 50% and DLIR-M in terms of CNR and SNR, with CNR improving by 25% and SNR by 30% compared to ASIR-V 50%. DLIR-H also demonstrated superior noise reduction, with a 35% reduction in SD compared to ASIR-V. Furthermore, by effectively suppressing the elevated image noise inherent to low-dose scanning protocols, DLIR maintained excellent diagnostic image quality. This highlights its potential for dose reduction in clinical practice, which is crucial for minimizing the risks of radiation exposure and contrast-induced nephropathy. For mesenteric DE-CTA imaging at 40keV, DLIR significantly improves objective image quality and subjective reader confidence compared to ASIR-V. By preserving fine vascular details at higher noise levels, DLIR demonstrates the potential to facilitate low-radiation and low-contrast-dose protocols in clinical practice.

Contrast-induced nephropathy (CIN) remains a leading cause of hospital-acquired acute kidney injury (AKI) despite progress in diagnosis and treatment. Objective. To perform an analysis of the prognostic significance of uromodulin as a biomarker for the risk of contrast-induced nephropathy development, determine its association with clinical outcomes and its role in stratifying patient groups before contrast-enhanced studies. Materials and methods. Current data on the significance of uromodulin as a predictor of the development of CIN were analyzed. Literature search was carried out in eLibrary, PubMed, Google Scholar and Scopus databases (2008—2025). Results. CIN diagnosis is a diagnosis of exclusion that is established based on the differential diagnosis of AKI of another etiology. In clinical practice, the traditional markers of AKI (serum creatinine level, diuresis) reflect its development in a delayed period of time after tubular apparatus damage. Uromodulin is the most accurate biomarker of renal tubular epithelial injury. Its level in urine decreases in the initial damage with radiopaque agents. As opposed to traditional AKI markers, the level of which increase after injury (e.g., NGAL, KIM-1), serum and urine uromodulin reflects the basic renal functional capacity. Determination of uromodulin level before performing contrast-enhanced studies may be an important element in the stratification of CIN risk, especially in patients with predisposition factors — old age, renal diseases, diabetes, heart failure. Conclusion. Uromodulin is a promising marker of tubule condition and risk stratification for contrast-induced nephropathy development. Its determination before contrast-enhanced procedures, especially in combination with other biomarkers, will increase prediction accuracy, optimize prevention and improve outcomes in high-risk patients.

Relation of High CHA₂DS₂-VASc Score With Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Background: The endothelial activation and stress index (EASIX), derived from the serum lactate dehydrogenase, creatinine, and platelet counts, is a composite biomarker for endothelial dysfunction and systemic stress. It has been developed to predict clinical outcomes in hematologic malignancies. This study aimed to investigate the EASIX's predictive role in contrast-induced nephropathy (CIN) and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 1552 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups: CIN (+) and CIN (-). Baseline demographic, laboratory, clinic, and procedural variables were compared between the two groups. Logistic regression analysis was performed to identify independent predictors of CIN and in-hospital mortality, while receiver operating characteristic (ROC) curves were used to determine the optimal EASIX cut-off values. Results: CIN developed in 7.6% (n = 118) of the study population, and these patients had significantly increased EASIX scores. Those with CIN were older and exhibited higher rates of diabetes mellitus, chronic kidney disease (CKD), and decreased left ventricular ejection fraction (LVEF) (all p < 0.001). In multivariable analysis, age (OR 1.053), CKD (OR 1.338), reduced LVEF (OR 0.965), and EASIX (OR 2.467) independently predicted CIN. EASIX > 0.93 demonstrated strong discriminatory ability (AUC 0.785; sensitivity 72% and specificity 72%). EASIX also independently predicted in-hospital mortality (OR 3.592), with an optimal cut-off > 0.88 (AUC 0.774). Conclusions: By integrating markers of renal function, endothelial activation, and systemic stress, EASIX may serve as a useful and reliable indicator for predicting CIN development and in-hospital mortality in STEMI patients undergoing primary PCI.

This study aimed to determine the effect of N-acetylcysteine (NAC) in preventing contrast-induced nephropathy. A literature search was carried out in PubMed and Cochrane CENTRAL, and 49 studies were finally included. With oral NAC, there was no difference in the incidence of acute kidney injury (AKI; OR: 1.00; 95% CI: 0.90- 1.11; p = 0.98), the need for haemodialysis (HD; OR: 0.94; 95% CI: 0.61- 1.46; p = 0.79), or mortality (OR: 1.08; 95% CI: 0.83- 1.41; p = 0.55). The results were not affected during subgroup analysis for low- or high-dose oral NAC. With intravenous (IV) NAC, there was no difference in the incidence of AKI (OR: 0.84; 95% CI: 0.67- 1.04; p = 0.19), the need for HD (OR: 0.74; 95% CI: 0.19- 2.86; p = 0.66), or mortality (OR: 1.11; 95% CI: 0.67- 1.85; p = 0.68). Neither oral nor IV NAC decreases the risk of contrast-induced nephropathy. Key Words: Acetylcysteine, Acute kidney injury, Mortality, Renal dialysis.

Contrast-induced nephropathy or contrast-induced acute kidney injury (CI-AKI) has been regarded for decades as arelevant complication of iodinated contrast medium administration, particularly in perioperative and intensive care settings. However, recent epidemiological and clinical data increasingly challenge this presumed causal relationship and suggest that the associated risk is substantially overestimated. The aim of this article is to critically appraise the current evidence and to reassess the clinical relevance of contrast medium administration within the context of multifactorial acute kidney injury development. This editorial is based on anarrative and commentary-driven analysis of selected clinical studies, meta-analyses, and current recommendations regarding the use of iodinated contrast media in perioperative and intensive care settings. The published data were evaluated with aparticular emphasis on patient-related risk factors and clinically relevant practical aspects. The majority of contemporary studies demonstrate no or only amarginal causal association between the administration of iodinated contrast media and the development of AKI. Instead, the occurrence of AKI closely correlates with patient-related factors such as pre-existing chronic kidney disease, hemodynamic instability, sepsis, and systemic inflammation. Preventive measures beyond individualized volume therapy and hemodynamic optimization have not shown consistent effectiveness. Contrast medium administration frequently appears to be amarker of severe disease rather than aprimary trigger for AKI. The long-assumed nephrotoxicity of iodinated contrast media requires reevaluation. From an anesthesiological perspective, the focus should shift away from contrast avoidance towards ensuring adequate organ perfusion and hemodynamic stability. Unwarranted reluctance to perform urgently indicated imaging may lead to diagnostic delays and potentially compromises patient safety. Arational evidence-based approach to contrast medium administration within an interdisciplinary risk-benefit assessment is essential.

26-A-16803-ACC IMPACT OF INTRA-CORONARY OPTICAL COHERENCE TOMOGRAPHY COMPARED TO INTRAVASCULAR ULTRASOUND AND CORONARY ANGIOGRAPHY ON CONTRAST-INDUCED NEPHROPATHY IN CORONARY INTERVENTION: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Saline vs Contrast for Optical Coherence Tomography During Percutaneous Coronary Intervention: A Prospective Multicenter Study.

Left ventricular lead (LVL) implantation can be challenging in Cardiac Resynchronization Therapy (CRT). Therefore, contrast is commonly used to visualize the coronary venous system. However, contrast use is correlated with substantial risks such as contrast-induced nephropathy and anaphylactic reaction. Case studies suggest feasibility of LVL implantation without coronary sinus (CS) venography. We aimed to compare the procedure characteristics, outcome, and safety of contrast-free and contrast-aided LVL implantation. 346 LVL implantations performed between 2017 and 2019 were analysed. 167 were attempted without contrast (Intervention Group: IG), and 179 were fully performed with contrast (Control Group: CG). The data was collected and analysed retrospectively from a single centre. These two groups were compared in an Intention-To-Treat (ITT) analysis. An As-Treated (AT) analysis was performed to compare procedures fully performed without contrast (NCG), crossover procedures (COG) and the control group (CG). The intervention duration, fluoroscopy duration, and radiation dose were evaluated as procedure characteristics. The primary outcome was procedural success. The secondary outcomes were LVL position, LVL threshold value, QRS duration and LVEF evolution. Perioperative complications and lead revisions were surrogates for the intervention’s safety. The overall LVL implantation success rate was 97.7%. Of the contrast-free procedures 62.9% were successful, the remainder required crossover to contrast use compared to 96.6% with contrast use. The ITT and AT analyses yielded similar results. Contrast-free interventions were associated with shorter procedure (100.8 ± 41.0 vs. 131.1 ± 50.0 min, p < 0.01), less fluoroscopy (15.7 ± 11.2 vs. 26.0 ± 17.5 min, p < 0.01) and smaller radiation doses, (475.3 ± 422.7 vs. 897.3 ± 779.1 cGy.cm2, p < 0.01). The intraoperative LVL threshold values were equivalent (0.9 ± 0.6 in the NCG vs. 1.0 ± 0.6 V in the CG, TOST-p < 0.01), and contrast use did not significantly influence the follow-up LVL threshold (1.1 ± 0.5 vs. 1.2 ± 0.9 V (p = 0.62), QRS shortening (10.5 ± 28.3 vs. −13.2 ± 26.3ms, p = 0.16) or LVEF increase − (2.3 ± 8% vs. 4.1 ± 8.4%, p = 0.40). More CS dissections were observed during the contrast-aided procedures (5% in the CG versus 3.2% in the COG versus 0% in the NCG, p = 0.03). However, the perioperative complication rates (pericardial effusion, ICU admission, death, mechanically induced arrhythmia, and pneumothorax) did not significantly differ (p > 0.05 for each). In contrast-free LVL implantation failure cases, intraoperatively crossing over from the NCG to CG did not result in longer procedures (131.8 ± 46.8 in the COG vs. 131.1 ± 50.0 min in the CG, p = 0.90). Although more adverse events were observed in the CG, the difference was not statistically significant (6.5% in the COG vs. 12.3% in the CG, p = 0.20). Contrast-free LVL implantation was associated with shorter intervention durations, less fluoroscopy and lower radiation doses. Fewer intraoperative complications were observed without contrast, and the postoperative complication rate was similar to contrast-aided procedures. This technique was successful in almost 2/3 of the cases. Where a crossover to contrast use was required, the initial contrast-free approach did not result in a statistically significant increase in clinically relevant adverse events compared with fully contrast-aided procedures. It is therefore reasonable to consider an initial contrast-free approach for CRT implantation. Central Illustration: Feasibility, procedural characteristics, and lead positioning of contrast-free LV lead implantation.

Background and Objectives: Chronic kidney disease (CKD) is associated with severe coronary calcification and increased procedural risks. We aimed to evaluate the impact of CKD on contrast-induced nephropathy (CIN), bleeding, and clinical outcomes in patients undergoing rotational atherectomy (RA). Materials and Methods: This study retrospectively analyzed 652 patients who underwent RA for calcified coronary lesions from the multicenter ROCK registry and a single-center extension between 2010 and 2025. Patients were classified into CKD (eGFR < 60 mL/min/1.73 m2, n = 66) and non-CKD (n = 586) groups, excluding those on dialysis. The primary endpoint was a composite of CIN and in-hospital bleeding. Secondary endpoints included 3-year target vessel failure (TVF), myocardial infarction (MI), and total bleeding. Results: The primary composite outcome occurred more frequently in the CKD group (16.7% vs. 5.1%, p = 0.001). Specifically, CIN was significantly higher in CKD patients (15.2% vs. 1.7%, p < 0.001), while in-hospital bleeding did not differ significantly. In multivariate analysis, CKD was an independent predictor of the primary outcome (adjusted OR 3.02; 95% CI 1.36-6.69; p = 0.006). At 3-year follow-up, total bleeding (10.6% vs. 3.9%, p = 0.008) and MI (6.1% vs. 2.1%, p = 0.024) were higher in the CKD group, whereas TVF and cardiac death showed no significant difference. Conclusions: CKD is a robust independent risk factor for CIN and long-term bleeding in patients undergoing RA. However, comparable clinical efficacy outcomes suggest that RA remains a feasible strategy in CKD patients when early complications are carefully managed with contrast-minimizing strategies.

Contrast-induced nephropathy (CIN) is an important cause of acute kidney injury following exposure to iodinated contrast media, and effective preventive strategies remain limited. This study investigated the renoprotective effects of riociguat, a soluble guanylate cyclase stimulator, in an experimental rat model of CIN and explored machine-learning-based prediction of renal injury using histopathological, biochemical, and inflammatory markers. Thirty-six female Wistar albino rats were randomized into control, riociguat, CIN model, and CIN + riociguat groups. CIN was induced by iohexol after dehydration, and riociguat was administered orally for 5 days. Renal injury was assessed by histopathological scoring, TUNEL assay, and biochemical parameters including serum creatinine, urea, tumor necrosis factor-alpha, nitric oxide, neutrophil gelatinase-associated lipocalin, and advanced oxidation protein products. Riociguat significantly decreased serum creatinine, urea, apoptotic index, and histopathological injury scores, reduced inflammatory and oxidative stress markers, and increased nitric oxide levels compared with untreated CIN animals (p < 0.05). Machine learning models (Random Forest, CatBoost, AdaBoost, and XGBoost) were applied for exploratory prediction and feature importance analysis. The apoptotic index and nitric oxide were identified as dominant predictors, indicating mechanistic relevance but limited clinical screening utility because these predictors require histological assessment. Overall, riociguat demonstrated significant renoprotective effects through anti-apoptotic, anti-inflammatory, and antioxidative mechanisms, and machine learning provided hypothesis-generating insight rather than a clinically deployable predictive model.

Contrast Medium (CM) is so toxic that it causes Contrast-Induced Nephropathy (CIN). It is the third most common cause of acute renal damage in inpatient settings. Effective therapies are scarce, and the pathophysiology of CIN is uncertain. The active substances and potential targets of SKI、CIN, and Ferroptosis-related genes were obtained through public databases. Overlapping targets of SKI, CIN, and Ferroptosis were analyzed using Protein-Protein Interaction (PPI) networks. GO and KEGG enrichment analyses were performed to predict SKI pathways against CIN, and key components and targets were screened for molecular docking. The results of network pharmacology analysis were verified using in vitro experiments. Fifteen potential ferroptosis-related targets of SKI were identified for preventing CIN. GO and KEGG enrichment analyses suggest a critical role for the HIF-1 signaling pathway. In vivo experiments demonstrated that intravenous contrast agents can induce CIN under specific conditions. Biomarker (Iron, MDA, and Glutathione Peroxidase 4) analysis and mitochondrial electron microscopy provided evidence supporting the occurrence of ferroptosis. Ferrostatin-1 (Fer-1) significantly mitigates CIN by suppressing ferroptosis. SKI and Fer-1 treatment downregulated STAT3, HIF-1α, and HMOX-1 at both protein and mRNA levels, whereas CIN conditions upregulated these markers. These results were further corroborated by in vitro cell experiments. This study shows that SKI inhibits oxidative stress and ferroptosis by regulating the STAT3 / HIF-1α / HMOX-1 signaling pathway, thereby reducing the occurrence of CIN, providing valuable insights for the development of multi-target therapies for the complex pathological mechanisms of CIN. The active compound SKI significantly reduced ferroptosis in HK-2 cells induced by CM. This finding suggests that SKI is a potentially effective treatment for CIN by modulating the STAT3/HIF-1α/HMOX-1 signaling pathway.

Transcatheter aortic valve replacement (TAVR) is being performed in increasingly complex, high-risk cohorts, and contrast-induced nephropathy (CIN) remains a major determinant of morbidity and mortality. The endothelial-damage score EASIX (lactate dehydrogenase × creatinine/platelet count) is a validated prognostic index in hematology and critical care but has never been explored after TAVR. We retrospectively analyzed 130 consecutive severe AC patients (mean age 76.8 ± 8.4 years; 47.8% male) who underwent transfemoral TAVR (February 2019–March 2021). CIN was defined as a ≥25% or ≥0.5 mg/dL creatinine rise within 72 hours. The predictive value of EASIX was assessed with receiver operating characteristic analysis and multivariable logistic regression. CIN occurred in 15.4% (n = 20). Baseline EASIX was higher in CIN+ vs CIN− (2.92 ± 1.28 vs 1.33 ± 1.30; P < .001). An EASIX threshold ≥ 1.904 predicted CIN with 90.3% sensitivity and 86.2% specificity (area under the curve 0.91; P < .001). In multivariable analysis, EASIX (OR 2.62; P = .023), contrast volume, and baseline eGFR independently predicted CIN. EASIX, obtainable from routine laboratories, is an independent, high-performance predictor of CIN after TAVR and may facilitate pre-procedural risk stratification.

The C-reactive protein-albumin-lymphocyte (CALLY) index integrates inflammation, nutrition, and immunity. Its value for predicting contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) is uncertain. We examined whether CALLY predicts CIN in non-ST-elevation myocardial infarction (NSTEMI). A total of 199 consecutive patients with NSTEMI who underwent PCI were retrospectively analyzed. Independent predictors were identified by multivariable logistic regression; discriminative performance was evaluated with receiver-operating characteristic (ROC) analysis. CIN occurred in 32 patients (16.1%). Patients with CIN had lower CALLY values [0.49 (0.05-1.71) vs. 1.79 (0.51-4.06); p < 0.001], lower HDL-cholesterol, higher baseline creatinine, and lower estimated glomerular filtration rate. In multivariable models, CALLY independently predicted lower CIN risk (odds ratio [OR] 0.781; 95% confidence interval [CI] 0.625-0.977; p = 0.031) alongside baseline creatinine (OR 6.002; 95% CI 1.196-30.123; p = 0.029) and HDL-cholesterol (OR 0.945; 95% CI 0.900-0.993; p = 0.024). CALLY showed moderate discrimination (AUC 0.697; p < 0.001); the optimal cutoff was 1.1074 (sensitivity 61.1%, specificity 62.5%). A lower CALLY index is independently associated with an increased risk of CIN in NSTEMI patients undergoing PCI. The CALLY index may serve as a tool for early risk stratification and targeted preventive strategies in this high-risk population.