Mehran Score Research Articles

The use of allopurinol in prophylaxis against contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Abstract Background Contrast-induced nephropathy (CIN) is a serious complication after percutaneous coronary intervention (PCI). Inflammation and development of reactive oxygen species are among the postulated mechanisms of CIN. Allopurinol with anti-inflammatory action could be a preventive method of CI-AKI. Aim of the work To determine the effect of adding allopurinol to hydration in the prevention of CIN in patients undergoing PCI, with or without hyperuricemia. Methods One hundred and seven patients with moderate to high Mehran score undergoing elective PCI were randomly allocated to the allopurinol (n=52) or the control group (n=55). Those in the allopurinol group (hyperuricemic n=25, and normouricemic n= 27) received allopurinol 300 mg one day and one hour before PCI beside intravenous hydration (1 ml/kg/hour) normal saline, a maximum of 100 ml/hour for 12 hours pre and post coronary angiography. Patients in the control group (hyperuricemic n=26 and normouricemic n=29), received the same intravenous hydration only. Serum creatinine and urea were measured before and 48 hours after the procedure while the uric acid level was measured before the procedure only. CIN was defined by a percentage increase in serum creatinine of ≥25% or absolute serum creatinine ≥0.5 mg/dl, 48 hours after PCI. Results The mean age of the studied patients was 59.6 ± 9.1 years old, 59% were male. No difference between both groups regarding baseline characteristics or medications. Average Mehran score was 9.0 ± 1.2. CIN was observed in 5 patients in the allopurinol group (9.6%) and 15 patients in the control group (27.3%) (P = 0.017). There was no significant difference between both groups regarding the contrast volume (179.8 ± 68.1 vs. 153.8 ± 57.9 ml, p: 0.052). Hyperuricemia had no significant effect on increasing the incidence of CI-AKI either in patients with or without CKD (p=0.964). Conclusion Allopurinol on the top of hydration was found to decrease the incidence of CIN following PCI in patients with moderate to high Mehran score for CIN. The anti-inflammatory action of allopurinol could be the mechanism of this favorable effect, as baseline uric acid didn't affect the results. Further multi-center study with a larger sample size is needed to offer more definite results.

Simplified rapid hydration and contrast-associated acute kidney injury among CKD patients stratified by Mehran score: sub-analysis from the TIME Trial

Simplified rapid hydration has been proven to be non-inferior to standard hydration in preventing contrast-associated acute kidney injury among chronic kidney disease patients undergoing coronary angiography. The current investigation aimed to further confirm the feasibility and safety of the newly proposed hydration method-simplified rapid hydration (SH) in each risk stratification by Mehran risk score (MRS). Eligible patients (n = 954) randomized to the SH group and standard hydration group were allocated into 2 groups based on MRS: low to moderate-risk and high to very high-risk groups. Primary endpoints were the incidence of contrast-associated acute kidney injury (CA-AKI) and acute heart failure (AHF) (SH vs standard hydration). Secondary endpoints included serum creatinine (Scr), blood urea nitrogen (BUN), cystatin-C (Cys-C), and C-reactive protein (CRP) at 24 h, 48 h, and 72 h after PCI procedure, and the incidence of major adverse cardiac events (MACE). MRS was associated with a higher incidence of CA-AKI (OR = 1.101, 95%CI 1.049–1.156, P < 0.001). In the low to moderate-risk and high to very-high-risk groups, the incidence of CA-AKI in the SH and standard hydration group was 3.3% versus 4.9% (P = 0.5342), 10% versus 12% (P = 0.6392), respectively. Meanwhile, there might be subtle differences in renal function indexes and inflammatory indicators between SH and the control group at different time points. The preventive effect of SH in CA-AKI was similar to standard hydration regardless of MRS-guided risk stratification.

Emergency CT Scans: Unveiling the Risks of Contrast-Associated Acute Kidney Injury.

This study aimed to identify the incidence and risk factors for contrast-associated acute kidney injury nephropathy (CA-AKI) in patients undergoing contrast-enhanced computed tomography (CCT) in the emergency department. In this retrospective single-center study, patients aged 18 and older who visited the emergency department and underwent CCT between January and February 2022 were included. The Mehran score, calculated from patient data, was used to assess risk. CA-AKI development was determined by measuring serum creatinine (SCr) levels 48-72 h post-contrast administration. The study included 532 patients, with a mean age of 57 ± 19 years; 53.2% were male. CA-AKI developed in 16% of cases, 5.82% required hemodialysis, and 7.9% died. The Mehran score was the only significant predictor of CA-AKI development. Patients with a Mehran score of 16 or higher had a 161-fold increased risk of developing CA-AKI compared to those with a score of 5 or lower. The model achieved a 91.3% correct classification rate. Logistic regression analysis showed that CA-AKI significantly increased mortality risk by 15.7 times. The Mehran score, originally developed for predicting CA-AKI risk post-coronary intervention, is also effective for predicting CA-AKI risk after CCT. While CA-AKI is a significant factor affecting mortality, it is not the sole cause of death (Nagelkerke R2 value 0.310).

Renoprotective Effect of Febuxostat on Contrast Induced Acute Kidney Injury in Chronic Kidney Disease Patients Stage 3. Randomized Controlled Trial

Abstract Introduction Contrast induced acute kidney injury (CI-AKI) is known to be a complication of using intravascular contrast injection. Unfortunately, It is associated with adverse outcomes as prolonged length of hospitalization and increased burden of health care costs. So, we aimed to determine the efficacy of febuxostat in prevention of contrast induced acute kidney injury among patients with chronic kidney disease Stage 3 performing percutaneous coronary intervention (PCI). Methods In a randomized controlled trial we enrolled 120 CKD stage 3 Patients with acute coronary syndrome referred to the cardiology department Ain-Shams University hospital for performing PCI and stenting. Patients were randomly assigned to two arms: Group I (study group): Included 60 patients who received Febuxostat added to the traditional treatment (IV hydration and N-acetylcysteine). The patients received Feburic 80 mg within 6- 18 hours before and within 6-18 hours after the coronary intervention (a time gap of 24 hours between two doses).Group II (control group): included 60 patients who received only traditional treatment. Results The incidence of AKI was higher in the control group with a statistically significant difference. We found that Independent Significant risk factors that led to AKI were febuxostate avoidance, DM, high urea level, high creatinine level, CKD stage 3B, high Mehran score and high AKI risk. Conclusion We demonstrated that febuxostat has a renoprotective effect and it can help to reduce the incidence CI-AKI in CKD patients stage 3 performing PCI.

The impact of the stress hyperglycemia ratio on the risk of contrast-associated acute kidney injury in patients undergoing coronary angiography: a large real-world cohort study

BackgroundContrast-associated acute kidney injury (CA-AKI) is an important complication in the perioperative period of coronary angiography (CAG). Dysglycemia is closely associated with the occurrence of CA-AKI. However, the association between stress hyperglycemia and CA-AKI in patients undergoing CAG remains unclear. The study aims to investigate the association of the stress hyperglycemia ratio (SHR) and CA-AKI under CAG in a large real-world cohort.MethodsThis was a retrospective observational study, and patients undergoing CAG were enrolled. SHR is calculated by dividing the random blood glucose with the estimated average glucose derived from the glycosylated hemoglobin (HbA1c), and subjects were divided into five groups according to SHR. The outcome was CA-AKI defined as an increase in serum creatinine of ≥ 0.3 mg/dL (26.5 μmol/L) or 1.5-fold higher than normal levels in 48 h. The association was assessed with logistic regression and restricted cubic spline analysis.ResultsIn 19,965 participants (men: 73.3%, mean age: 63.1 ± 10.8 years) undergoing CAG, a total of 1,621 CA-AKI cases occurred. There were reverse J-shaped associations between the SHR and CA-AKI after adjustment for other confounding factors. Moreover, SHR improved the predictive effectiveness of the traditional Mehran score (AUC 0.65 vs 0.63, P < 0.001), a predictive model of CA-AKI in patients undergoing percutaneous coronary intervention.ConclusionsThere were reverse J-shaped associations of SHR with CA-AKI risk among patients undergoing CAG, and the assessment of SHR before CAG may assist clinicians in identifying patients at higher risk of CA-AKI.

Inorganic nitrate benefits contrast-induced nephropathy after coronary angiography for acute coronary syndromes: the NITRATE-CIN trial.

Contrast-induced nephropathy (CIN), also known as contrast-associated acute kidney injury (CA-AKI) underlies a significant proportion of the morbidity and mortality following coronary angiographic procedures in high-risk patients and remains a significant unmet need. In pre-clinical studies inorganic nitrate, which is chemically reduced in vivo to nitric oxide, is renoprotective but this observation is yet to be translated clinically. In this study, the efficacy of inorganic nitrate in the prevention of CIN in high-risk patients presenting with acute coronary syndromes (ACS) is reported. NITRATE-CIN is a double-blind, randomized, single-centre, placebo-controlled trial assessing efficacy of inorganic nitrate in CIN prevention in at-risk patients presenting with ACS. Patients were randomized 1:1 to once daily potassium nitrate (12 mmol) or placebo (potassium chloride) capsules for 5 days. The primary endpoint was CIN (KDIGO criteria). Secondary outcomes included kidney function [estimated glomerular filtration rate (eGFR)] at 3 months, rates of procedural myocardial infarction, and major adverse cardiac events (MACE) at 12 months. This study is registered with ClinicalTrials.gov: NCT03627130. Over 3 years, 640 patients were randomized with a median follow-up of 1.0 years, 319 received inorganic nitrate with 321 received placebo. The mean age of trial participants was 71.0 years, with 73.3% male and 75.2% Caucasian; 45.9% had diabetes, 56.0% had chronic kidney disease (eGFR <60 mL/min) and the mean Mehran score of the population was 10. Inorganic nitrate treatment significantly reduced CIN rates (9.1%) vs. placebo (30.5%, P < .001). This difference persisted after adjustment for baseline creatinine and diabetes status (odds ratio 0.21, 95% confidence interval 0.13-0.34). Secondary outcomes were improved with inorganic nitrate, with lower rates of procedural myocardial infarction (2.7% vs. 12.5%, P = .003), improved 3-month renal function (between-group change in eGFR 5.17, 95% CI 2.94-7.39) and reduced 1-year MACE (9.1% vs. 18.1%, P = .001) vs. placebo. In patients at risk of renal injury undergoing coronary angiography for ACS, a short (5 day) course of once-daily inorganic nitrate reduced CIN, improved kidney outcomes at 3 months, and MACE events at 1 year compared to placebo.

Risk of acute kidney injury in elective percutaneous coronary intervention: A comparative study of radial and femoral access

The impact of vascular access type, specifically transradial versus transfemoral, on the occurrence of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. In this study, we aimed to compare the incidence of AKI between the two access groups.&#x0D; Methods. This prospective observational study involved 164 adult patients undergoing elective PCI. Patients were categorized into transfemoral (n = 100) and transradial (n = 64) groups. Demographic data, including age, sex, body surface area, and preoperative glomerular filtration rate, as well as clinical information such as the presence of baseline ventricular dysfunction, diabetes mellitus, hypertension, postoperative blood loss, and transfusion volume, were recorded. Serum creatinine levels within the first 48-72 hours postoperatively were also documented.&#x0D; Results. Out of 100 patients in the transfemoral group, 12 (12%) developed AKI compared with 2 patients out of 64 (3.13%) in the transradial group. In the logistic multivariate analysis, several independent risk factors for AKI in patients undergoing PCI were identified. These factors included age &gt;55 years (OR 2.88, 95% CI 1.09; 11.97, p = 0.046), diabetes (OR 4.82, 95% CI 1.12; 31.65, p = 0.039), preprocedural creatinine levels &gt; 0.85 mg/dL (OR 3.17, 95% CI 1.54; 17.96, p = 0.019), fluoroscopy time &gt; 10 min (OR 6.55, 95% CI 1.65; 26.03, p = 0.008), Mehran score indicating a risk of contrast-induced nephropathy &gt;8 (OR 4.23, 95% CI 1.25; 14.3, p = 0.020), and transfemoral access (OR 3.22, 95% CI 1.08; 18.54, p = 0.044).&#x0D; Conclusions. Transradial access is associated with a significant independent reduction in the incidence of post-PCI AKI compared with transfemoral access. Age &gt;55 years, diabetes, preprocedural creatinine &gt; 0.85 mg/dL, fluoroscopy time &gt; 10 min, Mehran score &gt;8, and transfemoral access were identified as independent risk factors for AKI in patients undergoing PCI.

Assessing contrast-induced nephropathy risk in older adults undergoing coronary angiography and intervention: The CV/GFR ratio versus Mehran score.

Contrast-induced nephropathy is a prevalent cause of hospital-acquired renal insufficiency and increases adverse events in older patients undergoing angiography and percutaneous coronary intervention. The Mehran risk score has been widely used in Vietnam to assess contrast-induced nephropathy risk in patients before coronary angiography and percutaneous coronary intervention. Recently, there has been a shift toward the adoption of simpler risk prediction models, such as the contrast volume-to-glomerular filtration rate ratio. This study aimed to (1) determine the incidence of contrast-induced nephropathy in older patients undergoing coronary angiography and/or percutaneous coronary intervention, and (2) compare the validity of the contrast volume-to-glomerular filtration rate ratio and the Mehran score in predicting contrast-induced nephropathy. This is a prospective cohort study conducted at a hospital in Vietnam from September 2019 to May 2020. Consecutive patients aged ⩾60 years who underwent coronary angiography and/or percutaneous coronary intervention were recruited. The contrast volume-to-glomerular filtration rate ratio and the Mehran score were evaluated for their predictive utility regarding contrast-induced nephropathy risk. The receiver operator characteristic was employed to calculate the area under the curve for both the contrast volume-to-glomerular filtration rate ratio and the Mehran score in predicting contrast-induced nephropathy. The study included 170 participants with a mean age of 70 years and 33.1% were female. Contrast-induced nephropathy was diagnosed in 9.4% of the participants. Participants with contrast-induced nephropathy exhibited a higher prevalence of chronic kidney disease, anemia, and heart failure. There was no significant difference between the area under the curves of the contrast volume-to-glomerular filtration rate ratio (0.79, 95% CI: 0.65-0.92), and the Mehran score (0.65, 95% CI: 0.51-0.82) in predicting contrast-induced nephropathy. Our findings indicate that contrast-induced nephropathy was prevalent among older patients following percutaneous coronary intervention. The contrast volume-to-glomerular filtration rate ratio demonstrated a good prognostic value for predicting contrast-induced nephropathy comparable to that of the Mehran score. Further research is needed to identify optimal cutoff values for the contrast volume-to-glomerular filtration rate ratio in older patients.

Comparative Evaluation of Intermountain Risk Score With Mehran Risk Score for Risk Estimation of Contrast-Induced Nephropathy and Short-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients.

Contrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.

The PRECISE-DAPT Score as a Predictor of Constrast Induced Nephropathy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Abstract Background In the ACS population, there are inherent difficulties in rapidly assessing CIN risk and instigating prophylactic measures. Moreover, these procedures often use increased contrast volume and the patients are more likely to be haemodynamically compromised, increasing their risk of renal impairment. This was a prospective observational cohort study conducted on 200 patients with acute coronary syndrome (ACS), and undergoing percutaneous coronary intervention (PCI); to evaluate the predictive value of PRECISE DAPT score for the development of contrast induced nephropathy (CIN). Aim of the Work To evaluate the predictive value of PRECISE DAPT score for the development of CIN in ACS patients undergoing PCI, and compare its predictive power to Mehran score, and to contrast volume/eGFR ratio. Patients and Methods A total of 200 patients who were diagnosed with ACS and undergoing PCI, were recruited from Ain Shams University Hospitals and enrolled in the study. The primary endpoint was the development of CIN after PCI. CIN defined as an increase of &amp;gt; 25%, and/or &amp;gt; 0.5 mg/dl in serum creatinine at 3-5 days after PCI when compared to baseline value. Results The median age of all patients was (55) years, the majority (74.5%) of patients were males; while (25.5%) were females; (6.5%) of patients had positive family history of CAD, (35.5%) had DM, (42%) had HTN, (18.5%) had Dyslipidemia, (10%) had history of anemia, and (10.5%) had previous indexed MI The median Contrast volume was 180 ml, the median duration of procedure was (50 min). LAD was the culprit artery in (65.5%) of cases, RCA in (21.5%) of cases, LCX in (13 %) of cases. (10.5%) of patients suffered post procedural CIN (n = 21), (3%) of patients had No reflow, (4.5%) had Major bleeding, (27.5%) had Minor bleeding, and (25%) had Acute Heart Failure. The average Mehran score was 5 (range from 1 to 28), the average PRECISE DAPT score was 18(range from 2 to 60), PRECISE-DAPT score showed excellent predictive value for CIN development (AUC = 0.91, 95% CI = 0.86 to 0.94, P &amp;lt; 0.0001). Best cut-off is score &amp;gt;27 (sensitivity = 85.7%, 95% CI = 63.7% - 97.0%, specificity = 87.7%, 95% CI = 82.0% - 92.1%; Jindex = 0.73). PRECISE-DAPT was superior to both Mehran score (ΔAUC = 0.12, P = 0.018) and CV/eGFR (ΔAUC = 0.19, 95%, P = 0.018). There was no statistically significant difference between Mehran and CV/eGFR. (ΔAUC = 0.07, P = 0.304). Conclusion PRECISE-DAPT score showed excellent predictive value in predicting the development of (CIN) in ACS population, AUC = 0.91 (P &amp;lt; 0.0001). Best cut-off is score &amp;gt; 27 (sensitivity = 85.7%, specificity = 87.7%), exceeding Mehran score and CV/eGFR ratio. Validation of Mehran score in ACS was achieved. It showed good predictive value, AUC = 0.79 (P &amp;lt; 0.0001). Best cut-off is Mehran score &amp;gt; 6 (sensitivity = 81.0%, specificity = 67.6%). There is no statistically significant difference between Mehran and CV/eGFR. Logistic regression analysis showed that; serum creatinine level pre-PCI, wall motion score index, LAD infarction, and PRECISE DAPT score; all had an independent effect on increasing the probability of CIN occurrence; with significant statistical difference (p &amp;lt; 0.05 for all). Abbreviations ACEI: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; AHA: American Heart Association; AKI: Acute kidney injury; AMI: Acute myocardial infarction; CI-AKI: Contrast-induced acute kidney injury; CIN: Contrast-induced nephropathy; CK-MB: Creatine kinase myocardial band; CM: Contrast media; CV/GFR: Contrast Volume/eGFR Ratio: Estimated Glomerular Filtration Rate.; DBP: Diastolic blood pressure; DM: Diabetes mellitus; EF: Ejection fraction; Gp: Glycoprotein; Hb: Hemoglobin; HOCM: High osmolar contrast media; IABP: Intra-aortic balloon; IQR: Inter-quartile range; LAD: Left anterior descending artery; LCX: Left circumflex coronary; MAP: Mean arterial blood pressure. MI: myocardial infarction.; MBG: Myocardial blush grade; MINOCA: Myocardial infarction in the absence of obstructive coronary artery disease; NSTEMI: Non-ST elevation myocardial infarction; PCI: Percutaneous coronary intervention; PLT: Platelets; RCA: Right coronary artery; ROC curve: Receiver operating characteristic analysis; SD: Standard deviation; STEMI: ST-segment elevation myocardial infarction; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery; TIMI: Thrombolysis in Myocardial Infarction; TLC: Total leucocytic count

A new indicator of contrast-induced nephropathy in patients undergoing elective coronary angiography: tissue doppler-derived E/(EA × SA) index.

Hemodynamic instability plays an important role in the development of contrast-induced nephropathy (CIN), which is an important complication of coronary angiography. Left ventricular (LV) end-diastolic pressure (LVEDP) accurately reflects hemodynamic changes. In clinical practice, measuring LVEDP invasively presents some challenges and is not always accessible. This study aimed to investigate the relationship between tissue Doppler-derived early diastolic conduction velocity (E)/[early mitral annular diastolic velocity (Ea), × peak systolic annular velocity (Sa)] index, an important surrogate for LVEDP, and CIN in patients undergoing elective coronary angiography (ECA). This retrospective study included 388 consecutive patients undergoing ECA. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to baseline values within 72 hours after ECA. Mehran score was calculated in all patients and systolic and diastolic functions were evaluated with Doppler echocardiography. The incidence of CIN was 9.7%. There was a positive correlation between LV EDP levels and LV E/(Ea × Sa) index (r = 0.691, p < 0.001). Higher LV E/(Ea × Sa) index (OR = 1.03, p < 0.001) and Mehran score (OR = 1.41, p < 0.001) were independent predictors of CIN. The threshold value of LV E/(Ea × Sa) index in predicting CIN was > 1.71 with 75.7% sensitivity and 84.3% specificity (AUC = 0.825). In patients undergoing ECA, the non-invasively measured E/(Ea × Sa) index can be used as a risk indicator for CIN.

Association Between Inflammatory Biomarkers and Contrast-induced Acute Kidney Injury in ACS Patients Undergoing Percutaneous Coronary Intervention: A Cross-sectional Study.

The present study aimed to evaluate the predictive role of inflammatory biomarkers in the development of contrast-induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The inflammatory biomarkers assessed were: platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), neutrophil-to-lymphocyte*platelet ratio (NLPR), systemic inflammatory index (SII), and systemic inflammation response index (SIRI). Overall, 950 patients undergoing PCI were enrolled. The frequency of CI-AKI was 15.2% (n = 144). The levels of NLR, MLR, NLPR, SII, and SIRI were higher in the CI-AKI group than in the Non-CI-AKI group (P < .05). The addition of NLR ≥2.96, dNLR ≥2.08, NLPR ≥.012, SII ≥558.04, and SIRI ≥1.13 to the Mehran score model significantly increased the area under the curve (P < .05). Multivariable logistic regression analyses indicated that inflammatory biomarkers were significantly associated with CI-AKI, including NLR ≥2.96 (OR = 1.588, P = .017), dNLR ≥2.08 (OR = 1.686, P = .007), SII ≥558.04 (OR = 1.521, P = .030), and SIRI ≥1.13 (OR = 1.601, P = .017). Therefore, inflammation is associated with the development of CI-AKI, and preoperative hematological inflammatory markers could predict the risk of CI-AKI in ACS patients undergoing PCI.

The Importance of Mehran Score to Predict Acute Kidney Injury in Patients with TAVI: A Large Multicenter Cohort Study.

Transcatheter aortic valve implantation (TAVI) has developed as an alternative to surgery for symptomatic high-risk patients with aortic stenosis (AS). An important complication of TAVI is acute kidney injury. The purpose of the study was to investigate if the Mehran Score (MS) could be used to predict acute kidney injury (AKI) in TAVI patients. This is a multicenter, retrospective, observational study including 1180 patients with severe AS. The MS comprised eight clinical and procedural variables: hypotension, congestive heart failure class, glomerular filtration rate, diabetes, age >75 years, anemia, need for intra-aortic balloon pump, and contrast agent volume use. We assessed the sensitivity and specificity of the MS in predicting AKI following TAVI, as well as the predictive value of MS with each AKI-related characteristic. Patients were categorized into four risk groups based on MS: low (≤5), moderate (6-10), high (11-15), and very high (≥16). Post-procedural AKI was observed in 139 patients (11.8%). MS classes had a higher risk of AKI in the multivariate analysis (HR 1.38, 95% CI, 1.43-1.63, p < 0.01). The best cutoff for MS to predict the onset of AKI was 13.0 (AUC, 0.62; 95% CI, 0.57-0.67), whereas the best cutoff for eGFR was 42.0 mL/min/1.73 m2 (AUC, 0.61; 95% CI, 0.56-0.67). MS was shown to be a predictor of AKI development in TAVI patients.

ST segment yükselmeli miyokard enfarktüsü olan hastalarda kontrast maddeye bağlı nefropati ile CANLPH skoru arasındaki ilişki

Aim: Contrast-induced nephropathy (CIN), a significant complication of percutaneous coronary intervention (PCI), is related to increased morbidity and mortality. It has been suggested that inflammation plays an important role in the development of CIN. This study aimed to investigate the prognostic role of the CANLPH score, a new indicator of inflammation, in predicting CIN and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI.&#x0D; Material and Method: This retrospective study included 1475 patients with STEMI undergoing PCI. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to the baseline value within 48 h after PCI. The preprocedural modified Mehran score was calculated for each patient. The CANLPH score was derived from the cut-off points of the platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and platelet/hemoglobin ratio to predict CIN.&#x0D; Results: The mean age of the patients was 62.0±14.3 years and the majority were male (69.8%). The incidence of CIN was determined as 11.5%. Multivariable regression analysis showed that increased CANLPH score (OR=4.49, p

Renoprotective effect of febuxostat on contrast-induced acute kidney injury in chronic kidney disease patients stage 3: randomized controlled trial

IntroductionContrast-induced acute kidney injury (CI-AKI) is known to be a complication of using intravascular contrast injection. Unfortunately, it is associated with adverse outcomes such as prolonged length of hospitalization and increased burden of health care costs. So, we aimed to determine the efficacy of febuxostat in the prevention of contrast-induced acute kidney injury among patients with chronic kidney disease Stage 3 performing percutaneous coronary intervention (PCI).MethodsIn a randomized controlled trial we enrolled 120 CKD stage 3 Patients with acute coronary syndrome referred to the cardiology department Ain-Shams University hospital for performing PCI and stenting. Patients were randomly assigned to two arms: Group I (study group): Included 60 patients who received Febuxostat added to the traditional treatment (IV hydration and N-acetylcysteine). The patients received Feburic 80 mg within 6–18 h before and within 6–18 h after the coronary intervention (a time gap of 24 h between two doses). Group II (control group): included 60 patients who received only traditional treatment.ResultsThe incidence of AKI was higher in the control group with a statistically significant difference. We found that Independent Significant risk factors that led to AKI were febuxostate avoidance, DM, high urea level, high creatinine level, CKD stage 3B, high Mehran score and high AKI risk.ConclusionWe demonstrated that febuxostat has a Reno protective effect and it can help to reduce the incidence CI-AKI in CKD patients stage 3 performing PCI.

Safety of Using Contrast Agents in Coronary Angiography in a Multidisciplinary Hospital in Volgograd

Contrast-induced nephropathy (CIN) is a serious adverse reaction to contrast agents used in radiography. It is important to study the epidemiology of CIN and the risk factors for developing the complication in order to improve the quality of care that patients receive during coronary interventions. The aim of the study was to investigate the incidence of CIN after coronary angiography (CAG) with iopromide and analyse the cost-effectiveness of using this contrast agent in a multidisciplinary hospital in Volgograd. Materials and methods . The first part of the study comprised a medical record review of 147 patients having undergone coronary interventions (CAG and its combinations with balloon angioplasty and stenting) in the cardiology department from September 2020 to October 2021. The review involved identifying CIN cases by serum creatinine changes, assigning CIN risk scores, and assessing the volume of the contrast agent used. The second part of the study included calculating the expenses of the hospital for purchasing the contrast agent, both in total and in average per CAG procedure. Results . Having analysed serum creatinine changes, the authors identified CIN in 46 (31.3%) of CAG patients. According to Mehran risk scores for developing CIN, the baseline risk was high in 4 (2.7%) patients, moderate in 35 (23.8%) patients, and low in 108 (73.5%) patients. On average, a CAG procedure used 126.19 ± 36.35 mL of the contrast agent. The volume of the contrast agent exceeded 100 mL in 66 (44.9%) patients and the maximum acceptable contrast dose (MACD) in 8 (5.4%) patients. The MACD values were calculated using R.J. Cigarroa’s formula. The average cost of a CAG procedure amounted to 1927.8 rubles. Conclusions . The authors identified CIN in one third of the CAG patients, and the highest incidence was observed in patients with diabetes mellitus and a high risk according to the Mehran score. The risk of developing CIN increased upon exceeding the maximum acceptable volume of the contrast agent. To reduce the risk of CIN, the authors recommend including MACD calculation using R.J. Cigarroa’s formula and risk assessment using the Mehran score in percutaneous coronary intervention protocols.

Contrast induced nephropathy in older Vietnamese patients undergoing coronary angiography and intervention

Abstract Funding Acknowledgements Type of funding sources: None. Background The prevalence of coronary heart disease increases with age and older people accounted for a large proportion of patients presenting with coronary heart disease. Advancement in percutaneous coronary intervention (PCI) has contributed to reduced mortality in patients with coronary artery disease. However, coronary angiography and percutaneous intervention have also increased the risk of developing contrast induced nephropathy (CIN), especially in older patients. More than ten risk assessment tools have been developed to predict CIN. Among these, the Mehran risk score has been the most commonly used in Vietnam. In recent years, new simple risk prediction models have been proposed, including the contrast volume-to-glomerular filtration rate ratio (CV/GFR ratio). The CV/GFR ratio is calculated as the ratio of contrast medium quantity to glomerular filtration rate. Purpose The aim of this study was to (1) examine the incidence of CIN in a cohort of older patients undergoing coronary angiography and/or PCI at a tertiary hospital in Vietnam, (2) compare the validity of the CV/GFR ratio and the Mehran score in predicting CIN, and (3) to identify optimal cut-off points of these scales by which can help identify older patients with high risk of developing CIN in this population. Methods A prospective observational study was conducted in patients aged ≥ 60 years at a tertiary hospital in Vietnam from September 2019 to May 2020. CIN was defined as 25% increase in serum creatinine from baseline or 0.5mg/dL absolute increase in serum creatinine occurring within 48 hours post IV contrast administration. The CV/GFR ratio and the Mehran score were applied for predicting risk of CIN. Previous studies suggest Mehran score &amp;gt;5 or CV/GFR ratio &amp;gt;3.7 as a predictor of an early abnormal increase in serum creatinine after PCI. Receiver Operator Characteristic (ROC) was applied to evaluate area under the curve (AUC) of the CV/GFR ratio and Mehran score in predicting CIN, and the sensitivity, specificity for common cut-off points that were suggested in previous studies. Results A total of 170 participants were included in this study. They had a mean age of 70 years, 33.1% were women. The incidence of CIN was 9.4%. Participants with CIN had higher prevalence of chronic kidney disease, heart failure and anaemia at admission. The AUC of the CV/GFR ratio against CIN was 0.79 (95%CI 0.65-0.92), and of the Mehran score against CIN was 0.65 (95%CI 0.51-0.82) (Figure 1). The sensitivity and specificity for common cut-off points of the CV/GFR ratio and Mehran score are presented in Figure 2. Conclusions Our study found that CIN was common in older patients after PCI. Both CV/GFR ratio and Mehran score had good diagnostic value for predicting CIN in the study participants.

Association of Radial Artery Access with Reduced Incidence of Acute Kidney Injury.

To determine if radial artery (RA) access compared with femoral artery (FA) access for percutaneous coronary intervention (PCI) is associated with a lower incidence of acute kidney injury (AKI). AKI results in substantial morbidity and cost following PCI. Prior studies comparing the occurrence of AKI associated with radial artery (RA) versus femoral artery (FA) access have mixed results. Using a large state-wide database, 14,077 patients (8,539 with RA and 5,538 patents with FA access) were retrospectively compared to assess the occurrence of AKI following PCI. To reduce selection bias and balance clinical data across the two groups, a novel machine learning method called a Generalized Boosted Model was conducted on the arterial access site generating a weighted propensity score for each variable. A logistic regression analysis was then performed on the occurrence of AKI following PCI using the weighted propensity scores from the Generalized Boosted Model. As shown in other studies, multiple variables were associated with an increase in AKI after PCI. Only RA access (OR 0.82; 95% CI 0.74-0.91) and male gender (OR 0.80; 95% CI 0.72-0.89) were associated with a lower occurrence of AKI. Based on the calculated Mehran scores, patients were stratified into groups with an increasing risk of AKI. RA access was consistently found to have a lower risk of AKI compared with FA access across these groups of increasing risk. Compared with FA access, RA access is associated with an 18% lower rate of AKI following PCI. This effect was observed among different levels of risk for developing AKI. Although developed from a retrospective analysis, this study supports the use of RA access when technically possible in a diverse group of patients.

Predictive Value of the Modified Mehran Score for Contrast-Induced Nephropathy After Transcatheter Aortic Valve Implantation.

Considering the increasing use of the transcatheter aortic valve implantation (TAVI) procedure, the relationship of contrast-induced nephropathy (CIN) with post-TAVI mortality has become important. The Mehran score was developed to detect the risk of CIN development after cardiac intervention. We aimed to compare the role of the modified Mehran score, which can be calculated pre-procedure, in predicting CIN development and compare it with the original Mehran score. We retrospectively collected data from TAVI procedures at our institution between December 2016 and June 2021; of 171 patients, 44 (25.7%) had CIN. We found no association between contrast media volume and CIN (387 ± 120 vs 418 ± 139mL, P = .303). High and very high modified Mehran score and preoperative C-reactive protein (CRP) level were independent risk factors for CIN development after TAVI procedure. The area under curve (AUC) was .686 with 95% CI: .591-.780 and P < .001, and also, with a cut-off point of >7.5 points, there was 79.5% sensitivity and 63.0% specificity; otherwise, with a cut-off point of >9.5 points, there was 54.5% sensitivity and 71.7% specificity, for the modified Mehran score. The modified Mehran score comes into prominence compared with the original Mehran score since it can be calculated pre-procedure.

SHOCK INDEX-C: A NEWFOUND SPECTRUM OF SHOCK INDEX WITH GREAT ACCURACY TO PREDICT CONTRAST INDUCED NEPHROPATHY IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION COHORT

Objectives: This study was conducted to assess the predictive value of Shock Index-Creatinine Clearance (SI-C) for the risk stratification of contrast induced nephropathy (CIN) in patients after primary percutaneous coronary intervention (PPCI). Methodology: 1150 consecutive patients of STEMI and candidates of PPCI presenting at our tertiary care cardiac center were included in this study. Patients with significant hemodynamic instability, allergic reaction to contrast agent or having exposure to contrast agent within a week prior to PPCI and those requiring renal replacement therapy were excluded from this study. SI-C and Mehran risk scores were calculated and the rise in post procedure serum creatinine level by 0.5 mg/dL or up to 25% from baseline was characterized as CIN. The predictive power of both SIC and Mehran risk score was assessed with help of receiver operating characteristic (ROC) curve analysis. Results: Out of 1150 participants, 960 were male with a mean age of 55.64 ± 11.45 years. Out of which 113 (9.8%) patients developed CIN. Area under the cure (AUC) for the prediction of CIN was 0.702 [95% confidence interval (CI): 0.651 to 0.753] for SI-C as against 0.633 [95% CI: 0.574 to 0.692] for Mehran score. SIC also retained its statistical significance as independent predictor of CIN with adjusted odds ratio of 1.01 [95% CI: 1.01 to 1.02] on multivariable regression analysis. Conclusion: SI-C has demonstrated strong discriminative power to determine the risk of CIN in PPCI setting when compared with Mehran risk score.