Combined Value of Contrast-Induced Nephropathy and the CHA2DS2-VASc Score for Predicting Mortality in Patients with Acute Coronary Syndrome Who Were Undergoing Percutaneous Coronary Intervention

Abstract

Introduction: Both contrast-induced nephropathy (CIN) and CHA2DS2-VASc score have predictive valuefor mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronaryintervention (PCI), whereas the prognostic significance CHA2DS2-VASc of risk score combined with CINremains unclear. This study was designed to explore the combined value of CIN and CHA2DS2-VASc scorefor predicting long-term mortality in these patients.Patients and Methods: This retrospective study included 1058 consecutive patients with ACS who weretreated with PCI. CIN was defined as a serum creatinine increase ? 0.5 mg/dL or ? 25% within 48-72 hoursafter contrast exposure. The patients were divided into two groups, as survivors or nonsurvivors.Results: The CHA2DS2-VASc score and CIN were independently predictive for all-cause mortality (HR: 1.444,95% CI: 1.327-1.572, p< 0.001; HR: 1.850, 95% CI: 1.298-2.637, p= 0.001, respectively). Also, multivesseldiseases, Killip ? 2, beta blockers, and ACE/ARB use at follow-up were independently risk factors for allcause mortality. Adding CIN on top of the CHA2DS2-VASc score yielded superior risk-predictive capacitybeyond CHA2DS2-VASc score alone [AUC: 0.735 (0.701-0.769)], which is shown by improved AUC [AUC:0.754 (0.720-0.787, difference p= 0.0149)] as well as net reclassification improvement (NRI 28.5%, p< 0.001)and integrated discrimination improvement (IDI 0.021, p< 0.001).Conclusion: Our study demonstrated that combining the predictive value of CIN and the CHA2DS2-VAScscore yielded a more accurate predictive value for long-term mortality in ACS patients who underwent PCI ascompared to the CHA2DS2-VASc score alone.