Age, glomerular filtration rate, ejection fraction, and the AGEF score predict contrast‐induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Issue 6 (27th June 2013)

• Record Type: Journal Article
• Authors: Andò, Giuseppe; Morabito, Gaetano; de, Cesare; Trio, Olimpia; Saporito, Francesco; Oreto, Giuseppe
• Is Part Of: Catheterization and cardiovascular interventions. Volume 82:Issue 6(2013:Nov. 15)
• Page Start: 878
• Page End: 885
• Publication Date: 2013-06-27
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25023
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25023-sec-0001" sec-type="section"> <title>Background</title> <p>In patients undergoing primary percutaneous coronary interventions (PCI) for ST‐segment elevation myocardial infarction (STEMI), the occurrence of Contrast‐Induced Nephropathy (CIN) has a pronounced impact both on morbidity and mortality. We investigated the variables associated with CIN development in 481 consecutive patients with STEMI undergoing primary PCI and evaluated the predictive value of a 3‐variable clinical risk score (the AGEF score) based on age, left ventricular ejection fraction (EF), and estimated glomerular filtration rate (eGFR).</p> </sec> <sec id="ccd25023-sec-0002" sec-type="section"> <title>Methods</title> <p>CIN was defined as an absolute increase in serum creatinine ≥0.5 mg/dL or an increase ≥25% from baseline within 72 hr. AGEF score was calculated by adding 1 point to the Age/EF(%) ratio if the eGFR was <60 mL/min per 1.73 m<sup>2</sup>.</p> </sec> <sec id="ccd25023-sec-0003" sec-type="section"> <title>Results</title> <p>Overall, the incidence of CIN was 5.2%. In‐hospital mortality was higher in patients with CIN than in those without (16% Vs 1.3%, <italic>P</italic> = 0.001). At multivariate analysis age (OR 1.06, <italic>P</italic> = 0.042), eGFR (OR 0.95, <italic>P</italic> = 0.001), EF (OR 0.94, <italic>P</italic> = 0.007) and post‐procedural TIMI flow grade (OR 0.43, <italic>P =</italic> 0.045) were independent predictors of CIN. AGEF score was an accurate (OR 5.19, <italic>P</italic> < 0.001, AUC 0.88) and calibrated (Hosmer‐Lemeshow <italic>χ</italic><sup>2</sup> = 10.25, <italic>P =</italic> 0.25) predictor of CIN.</p> </sec> <sec id="ccd25023-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Advanced age, depressed EF, and reduced eGFR are independent predictors of CIN development after primary PCI for STEMI. The preprocedural individual patient risk can be clinically assessed with the calculation of the AGEF score, which is based on such readily available parameters. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>