Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions

Abstract

Objectives: This study aimed to compare Mehran Risk Score (MRS) with three well -known scoring systems namely CHA2DS2-VASc score, Canada Acute Coronary Syndrome Risk Score (C-ACS), and Thrombolysis in Myocardial Infarction risk index (TRI) to predict the contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI). Background: CI-AKI is a common complication after primary PCI associated with an adverse prognosis. Methods: In this study consecutive patients of primary PCI were included. Patients with chronic kidney diseases, exposure to the contrast medium within the past 7 days, and Killip class IV at presentation were excluded. MRS along with three risk scores namely CHA2DS2-VASc, C-ACS, and TRI were calculated for all patients and CI-AKI was defined as either 0.5 mg/dL or 25% relative increase in post-procedure serum creatinine. The area under the curve (AUC) curve was reported. Results: Post primary PCI CI-AKI was observed in 63 (9.1%) patients out of 691 patients. The AUC was 0.745 [0.679–0.810] for MRS, 0.725 [0.662–0.788] for CHA2DS2-VASc, 0.671 [0.593–0.749] for C-ACS, and 0.734 [0.674–0.795] for TRI. Sensitivity and specificity were 61.9% [48.8–73.8%] and 76.0% [72.4–79.3%] for MRS ≥ 6.5, 66.7% [53.7–78.0%] and 66.7% [62.9–70.4%] for CHA2DS2-VASc ≥ 2, 52.4% [39.4–65.1%] and 79.9% [76.6–83.0%] for C-ACS ≥ 1, and 87.3% [76.5–94.4%] and 49.2% [45.2–53.2%] for TRI ≥ 16 respectively. Conclusions: The MRS has shown higher discriminating power than CHA2DS2-VASc, C-ACS, and TRI. However, the TRI can be of good value in clinical practice due to its simplicity and high sensitivity in detecting patients at higher risk of CI-AKI after primary PCI.

Keywords

• CI-AKI
• Primary PCI
• CHA2DS2-VASc score
• Canada-ACS Risk Score
• TIMI risk index (TRI)