Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification

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Abstract

Radiocontrast-induced nephropathy (RCIN) after percutaneous coronary intervention (PCI) is associated with grave consequences, but risk stratification of patients has not been well elucidated. This analysis derived a time-insensitive score to predict the risk of RCIN after PCI. A derivation cohort (1993 to 1998) and a validation cohort (1999 to 2002) comprised 20,479 patients who underwent PCI. RCIN after PCI was defined as a ≥1.0 mg/dl increase in serum creatinine. Variables having an independent correlation for RCIN after PCI were used to derive the RCIN risk score from the derivation cohort and were tested in the validation cohort. RCIN occurred in 2% of patients after PCI. Independent variables (with weighted scores) include estimated creatinine clearance <60 ml/min (2), urgent PCI (2), intra-aortic balloon pump use (2), diabetes mellitus (1), congestive heart failure (1), hypertension (1), peripheral vascular disease (1), and contrast volume >260 ml (1). The incidence of RCIN after PCI increased with each unit increase in score (p <0.0001, concordance statistic 0.89). No patient with a score ≤1 developed nephropathy, whereas 26% of patients with a score ≥9 developed RCIN after PCI (p <0.0001). Propensity score analysis showed that patients who developed RCIN after PCI, irrespective of the need for hemodialysis, had higher in-hospital rates of major adverse cardiac events (odds ratio 15, 95% confidence interval 11 to 20, p <0.0001). RCIN occurred in 2.0% of PCI patients and was associated with a 15-fold increase in adverse cardiac events. The RCIN risk score was a clinical assessment tool with excellent predictive ability in identifying the larger population at risk for nephropathy in whom preventative strategies are indicated.

Section snippets

Study sample

A database of patients who underwent coronary interventional procedures at William Beaumont Hospital (Royal Oak, Michigan) was tabulated. This database included demographic, clinical, and angiographic characteristics of 20,479 patients from 1993 to 2002 having 31,331 coronary interventions. For those patients who underwent ≥1 PCI (n = 10,162), the procedure associated with nephropathy was chosen for analysis; otherwise, the most recent procedure was used. Patients with any form of prior

Results

RCIN occurred in 2% (407 of 20,479) of our study population. The incidence of RCIN after PCI decreased from 2.8% in the derivation cohort (1993 to 1998) to 1.2% in the validation cohort (1999 to 2002; p <0.0001). The baseline characteristics of the study population are presented in Table 1. The mean increase in serum creatinine in patients without RCIN was 0.08 mg/dl (0.2 mg/dl, 90th percentile) versus 2.3 mg/dl (4.3 mg/dl; 90th percentile; p <0.0001) in patients with RCIN. Baseline increases

Discussion

We used the prospectively collected characteristics of a large, all-comer cohort of patients who underwent PCI to develop a time-insensitive clinical scoring system able to predict the development of RCIN. RCIN occurred in 2% of patients and was associated with a 15-fold increase in major adverse cardiac events compared with those patients without RCIN. The RCIN risk score uses the simple addition of 8 key variables to predict the risk of RCIN after PCI, thus providing excellent discrimination

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  • Cited by (0)

    Dr. O'Neill received research funding from Abbott Pharmaceuticals (Abbott Park, Illinois) for the study of radiocontrast-induced nephropathy.

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