Association of the blood urea nitrogen-to-left ventricular ejection fraction ratio with contrast-induced nephropathy in patients with acute coronary syndrome who underwent percutaneous coronary intervention

Abstract

AimWe investigated the predictive value of the blood urea nitrogen-to-left ventricular ejection fraction ratio (BUNEFr) to evaluate the risk of contrast-induced nephropathy (CIN) in acute coronary syndrome (ACS) patients who were treated with percutaneous coronary intervention (PCI).MethodsA total of 1010 ACS patients undergoing PCI were included in this study. The serum creatinine level was measured before and within 48-72h of contrast medium administration. Contrast-induced nephropathy was defined as an absolute increase of 0.3mg/dL or a relative increase of 25% from baseline serum creatinine within 48-72h of contrast medium exposure. To evaluate the relation between BUNEFr and CIN, the patients were divided into a CIN group and a no-CIN group.ResultsA total of 74 patients developed CIN (7.3%). Patients with CIN were older and had a higher BUNEFr than those without. Multivariate analysis showed that age, hypotension or positive inotrope support, history of stroke, contrast volume, and BUNEFr (OR 10.59, 95% CI 2.803-40.070, p=0.001) were independent predictors of CIN. For the development of CIN, the AUC of a multivariable model that included hypotension or positive inotrope support, history of stroke, and contrast volume was 0.813 (95% CI 0.758-0.857, p<0.001). When BUNEFr was added to a multivariable model, the AUC was 0.859 (95% CI 0.814-0.894, z=3.204, difference p=0.0014). Moreover, the addition of BUNEFr to a multivariable model was associated with a significant net reclassification improvement estimated at 49.4% (p<0.001) and an integrated discrimination improvement of 0.044 (p=0.0138).ConclusionThe BUNEFr may be a useful new predictor of CIN in ACS patients treated with PCI. The inclusion of BUNEFr in a multivariable model could allow improved risk classification in these patients regarding the development of CIN.