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

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Abstract

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.

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Authors and Affiliations

  1. Cardiology Service, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil

    Gustavo N. Araujo, 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

  2. School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Gustavo N. Araujo, Bruno Fuhr, Elvis P. Cassol, Guilherme P. Machado, Felipe H. Valle, Carisi A. Polanczyk & Marco V. Wainstein

Authors
  1. Gustavo N. Araujo
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  2. Fernando Pivatto Junior
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  3. Bruno Fuhr
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  4. Elvis P. Cassol
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  10. Marco V. Wainstein
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Correspondence to Gustavo N. Araujo.

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

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The authors declare that they have no conflicts of interest.

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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.

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Araujo, G.N., Pivatto Junior, F., Fuhr, B. et al. Simplifying contrast-induced acute kidney injury prediction after primary percutaneous coronary intervention: the age, creatinine and ejection fraction score. Cardiovasc Interv and Ther 33, 224–231 (2018). https://doi.org/10.1007/s12928-017-0472-y

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  • DOI: https://doi.org/10.1007/s12928-017-0472-y

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