Simplifying contrast-induced acute kidney injury prediction after primary percutaneous coronary intervention: the age, creatinine and ejection fraction score

  • Gustavo N. AraujoEmail author
  • Fernando Pivatto Junior
  • Bruno Fuhr
  • Elvis P. Cassol
  • Guilherme P. Machado
  • Felipe H. Valle
  • Luiz C. Bergoli
  • Rodrigo V. Wainstein
  • Carisi A. Polanczyk
  • Marco V. Wainstein
Original Article


Contrast-induced acute kidney injury (CI-AKI) is a common event after percutaneous coronary intervention (PCI). Presently, the main strategy to avoid CI-AKI lies in saline hydration, since to date none pharmacologic prophylaxis proved beneficial. Our aim was to determine if a low complexity mortality risk model is able to predict CI-AKI in patients undergoing PCI after ST elevation myocardial infarction (STEMI). We have included patients with STEMI submitted to primary PCI in a tertiary hospital. The definition of CI-AKI was a raise of 0.3 mg/dL or 50% in post procedure (24–72 h) serum creatinine compared to baseline. Age, glomerular filtration and ejection fraction were used to calculate ACEF-MDRD score. We have included 347 patients with mean age of 60 years. In univariate analysis, age, diabetes, previous ASA use, Killip 3 or 4 at admission, ACEF-MDRD and Mehran scores were predictors of CI-AKI. After multivariate adjustment, only ACEF-MDRD score and diabetes remained CI-AKI predictors. Areas under the ROC curve of ACEF-MDRD and Mehran scores were 0.733 (0.68–0.78) and 0.649 (0.59–0.70), respectively. When we compared both scores with DeLong test ACEF-MDRDs AUC was greater than Mehran’s (P = 0.03). An ACEF-MDRD score of 2.33 or lower has a negative predictive value of 92.6% for development of CI-AKI. ACEF-MDRD score is a user-friendly tool that has an excellent CI-AKI predictive accuracy in patients undergoing primary percutaneous coronary intervention. Moreover, a low ACEF-MDRD score has a very good negative predictive value for CI-AKI, which makes this complication unlikely in patients with an ACEF-MDRD score of <2.33.


Acute myocardial infarction Primary percutaneous coronary intervention Contrast-induced acute kidney injury Prediction models 


Compliance with ethical standards


Fundo de Incentivo à Pesquisa do Hospital de Clinicas de Porto Alegre (FIPE-HCPA), a governmental funding agency.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105:2259–64.CrossRefPubMedGoogle Scholar
  2. 2.
    James MT, Samuel SM, Manning MA, Tonelli M, Ghali WA, Faris P, et al. Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis. Circ Cardiovasc Interv. 2013;6:37–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Moscucci M. Contrast-induced acute kidney injury: the continuous quest for pharmacological prevention. Circ Cardiovasc Interv. 2012;5:741–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393–9.PubMedGoogle Scholar
  5. 5.
    Abellás-Sequeiros RA, Raposeiras-Roubin S, Abu-Assi E, González-Salvado V, Iglesias-Álvarez D, Redondo-Diéguez A, et al. Mehran contrast nephropathy risk score: is it still useful 10 years later? J Cardiol. 2016;67:262–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Wi J, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, et al. Prediction of contrast-induced nephropathy with persistent renal dysfunction and adverse long-term outcomes in patients with acute myocardial infarction using the Mehran risk score. Clin Cardiol. 2013;36:46–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Araujo GN, Wainstein MV, McCabe JM, Huang PH, Govindarajulu US, Resnic FS. Comparison of two risk models in predicting the incidence of contrast-induced nephropathy after percutaneous coronary intervention. J Interv Cardiol. 2016;29:447–53.CrossRefPubMedGoogle Scholar
  8. 8.
    Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation. 2009;119:3053–61.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee JH, Bae MH, Yang DH, Park HS, Cho Y, Jeong MH, et al. Prognostic value of the age, creatinine, and ejection fraction score for 1-year mortality in 30-day survivors who underwent percutaneous coronary intervention after acute myocardial infarction. Am J Cardiol. 2015;115:1167–73.CrossRefPubMedGoogle Scholar
  10. 10.
    Wykrzykowska JJ, Garg S, Onuma Y, de Vries T, Goedhart D, Morel MA, et al. Value of age, creatinine, and ejection fraction (ACEF score) in assessing risk in patients undergoing percutaneous coronary interventions in the ‘All-Comers’ LEADERS trial. Circ Cardiovasc Interv. 2011;4:47–56.CrossRefPubMedGoogle Scholar
  11. 11.
    Capodanno D, Marcantoni C, Ministeri M, Dipasqua F, Zanoli L, Rastelli S, et al. Incorporating glomerular filtration rate or creatinine clearance by the modification of diet in renal disease equation or the Cockcroft-Gault equations to improve the global accuracy of the age, creatinine, ejection fraction (ACEF) score in patients undergoing percutaneous coronary intervention. Int J Cardiol. 2013;168:396–402.CrossRefPubMedGoogle Scholar
  12. 12.
    Lakhal K, Ehrmann S, Chaari A, Laissy JP, Régnier B, Wolff M, et al. Acute kidney injury network definition of contrast-induced nephropathy in the critically ill: incidence and outcome. J Crit Care. 2011;26:593–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Sheehan FH, Braunwald E, Canner P, Dodge HT, Gore J, Van Natta P, et al. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the thrombolysis in myocardial infarction (TIMI phase I) trial. Circulation. 1987;75:817–29.CrossRefPubMedGoogle Scholar
  14. 14.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012;27:4263–72.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Blanc B, Finch CA, Halberg L, Herbert V, Lawkowicz W, Larysse M, et al. Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser. 1968;405:5–37.Google Scholar
  17. 17.
    Brown JR, MacKenzie TA, Maddox TM, Fly J, Tsai TT, Plomondon ME, et al. Acute kidney injury risk prediction in patients undergoing coronary angiography in a National Veterans Health Administration Cohort with external validation. J Am Heart Assoc. 2015;4:1–15.CrossRefGoogle Scholar
  18. 18.
    Bartholomew BA, Harjai KJ, Dukkipati S, Boura JA, Yerkey MW, Glazier S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol. 2004;93:1515–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Gurm HS, Seth M, Kooiman J, Share D. A novel tool for reliable and accurate prediction of renal complications in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2013;61:2242–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Tziakas D, Chalikias G, Stakos D, Apostolakis S, Adina T, Kikas P, et al. Development of an easily applicable risk score model for contrast-induced nephropathy prediction after percutaneous coronary intervention: a novel approach tailored to current practice. Int J Cardiol. 2013;163:46–55.CrossRefPubMedGoogle Scholar
  21. 21.
    Ivanes F, Isorni MA, Halimi JM, Fauchier L, Saint Etienne C, Babuty D, et al. Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty. Arch Cardiovasc Dis. 2014;107:424–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Liu YH, Liu Y, Tan N, Chen JY, Chen J, Chen SH, et al. Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention. Int Urol Nephrol. 2014;46:417–26.CrossRefPubMedGoogle Scholar
  23. 23.
    Elbasan Z, Sahin DY, Gür M, Kuloglu O, Kivrak A, Icen YK, et al. Contrast-induced nephropathy in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Angiology. 2014;65:37–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Capodanno D, Ministeri M, Dipasqua F, Dalessandro V, Cumbo S, Gargiulo G, et al. Risk prediction of contrast-induced nephropathy by ACEF score in patients undergoing coronary catheterization. J Cardiovasc Med (Hagerstown). 2016;17:524–9.CrossRefGoogle Scholar
  25. 25.
    Centola M, Lucreziotti S, Salerno-Uriarte D, Sponzilli C, Ferrante G, Acquaviva R, et al. A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int J Cardiol. 2016;210:4–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Liu Y, Zhou Y, He P, Yu D, Li L. Comparison of different risk scores for predicting contrast induced nephropathy and outcomes after primary percutaneous coronary intervention in patients with ST elevation myocardial infarction. Am J Cardiol. 2016;117:1896–903.CrossRefPubMedGoogle Scholar
  27. 27.
    Silvain J, Collet JP, Montalescot G. Contrast-induced nephropathy: the sin of primary percutaneous coronary intervention? Eur Heart J. 2014;35:1504–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Rudnick M, Feldman H. Contrast-induced nephropathy: what are the true clinical consequences? Clin J Am Soc Nephrol. 2008;3:263–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Sato A, Hoshi T, Kakefuda Y, Harunari T, Watabe H, Hiraya D, et al. Effect of the Mehran risk score for the prediction of clinical outcomes after percutaneous coronary intervention. J Cardiol. 2015;66:417–22.CrossRefPubMedGoogle Scholar
  30. 30.
    Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Spartà I, et al. Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv. 2010;3:491–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Ando G, Morabito G, de Gregorio C, Trio O, Saporito F, Oreto G. Age, glomerular filtration rate, ejection fraction, and the ACEF-MDRD score predict contrast-induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv. 2013;82:878–85.CrossRefPubMedGoogle Scholar
  32. 32.
    Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. ESC/EACTS myocardial revascularization guidelines 2014. Eur Heart J. 2014;35:3235–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2017

Authors and Affiliations

  • Gustavo N. Araujo
    • 1
    • 2
    Email author
  • Fernando Pivatto Junior
    • 1
  • Bruno Fuhr
    • 1
    • 2
  • Elvis P. Cassol
    • 1
    • 2
  • Guilherme P. Machado
    • 1
    • 2
  • Felipe H. Valle
    • 1
    • 2
  • Luiz C. Bergoli
    • 1
  • Rodrigo V. Wainstein
    • 1
  • Carisi A. Polanczyk
    • 1
    • 2
  • Marco V. Wainstein
    • 1
    • 2
  1. 1.Cardiology ServiceHospital de Clinicas de Porto AlegrePorto AlegreBrazil
  2. 2.School of MedicineFederal University of Rio Grande do SulPorto AlegreBrazil

Personalised recommendations