Association of Mehran risk score and contrast-induced nephropathy in patients undergoing primary PCI

Tanvir Adnan; Fazila Tun Nesa Malik; Kalimuddin; Nazir Ahmed; Mir Nesaruddin Ahmed; Ireen Akhter; Sami Nazrul Islam; Kamrul Hasan; Sayem Bin Latif

doi:10.18203/2320-6012.ijrms20260599

Authors

Tanvir Adnan Department of Cardiology, Asgar Ali Hospital, Dhaka, Bangladesh
Fazila Tun Nesa Malik Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
Kalimuddin Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
Nazir Ahmed Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
Mir Nesaruddin Ahmed Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
Ireen Akhter Department of Obstetrics and Gynecology, Shaheed Suhrawardi Medical College Hospital, Dhaka, Bangladesh
Sami Nazrul Islam Department of Cardiology, Universal Medical College Hospital, Dhaka, Bangladesh
Kamrul Hasan Department of Cardiology, Popular Medical College Hospital, Dhaka, Bangladesh
Sayem Bin Latif Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260599

Keywords:

Acute myocardial infarction, Contrast-induced nephropathy, Mehran risk score, Primary PCI, STEMI

Abstract

Background: Contrast-induced nephropathy (CIN) remains a common and serious complication following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Early risk stratification is essential to identify high-risk patients. The Mehran CIN risk score is widely used in elective PCI, but evidence in the primary PCI setting is limited. This study aimed to evaluate the association between Mehran risk score and the development of CIN in STEMI patients undergoing primary PCI.

Methods: This cross-sectional analytical study was conducted in the department of cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, from January 2018 to July 2019. Consecutive STEMI patients undergoing primary PCI were enrolled using a non-randomized purposive sampling method.

Results: Among the study population, 34 (13.7%) patients developed CIN, while 214 (86.3%) did not. CIN occurred most frequently in higher Mehran risk categories, with a statistically significant association (p<0.05). Factors such as anemia, diabetes mellitus, baseline serum creatinine >1.5 mg/dl, eGFR <60 ml/minute/1.73 m², and age >75 years were significantly associated with CIN. The ROC analysis showed an area under the curve of 0.774 (95% CI: 0.692-0.855; p<0.001). A Mehran score of 8 demonstrated 70% sensitivity and 71% specificity, while a score of 9 showed 61% sensitivity and 78% specificity.

Conclusions: The Mehran CIN risk score is a useful and reliable tool for predicting contrast-induced nephropathy in STEMI patients undergoing primary PCI and may aid in early risk stratification and preventive strategies.

Metrics

Metrics Loading ...

References

Koowattanatianchai S, Chantadansuwan T, Kaladee A, Phinyo P, Patumanond J. Practical risk stratification score for prediction of contrast-induced nephropathy after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Cardiol Res. 2019;10(6):350. DOI: https://doi.org/10.14740/cr939

Kumar R, Ahmed T, Khatti S, Memon AU, Shaikh NA, Farooq F, et al. Validity of Mehran risk score for predicting contrast induced nephropathy in modern primary percutaneous coronary interventions era. Pak Heart J. 2022;55(1):73-8. DOI: https://doi.org/10.47144/phj.v55i1.2183

Abdel-Ghany M, Morsy G, Kishk YT. Predictors of contrast-induced nephropathy in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Egypt J Intern Med. 2021;33(1):16. DOI: https://doi.org/10.1186/s43162-021-00043-2

Valappil SP, Kunjukrishnapillai S, Iype M, Koshy AG, Viswanathan S, Gupta PN, et al. Predictors of contrast induced nephropathy and the applicability of the Mehran risk score in high risk patients undergoing coronary angioplasty- a study from a tertiary care center in South India. Indian Heart J. 2018;70(3):399-404. DOI: https://doi.org/10.1016/j.ihj.2017.08.018

Liu X, Zhang P, Zhang J, Zhang X, Yang S, Fu N. The preventive effect of alprostadil on the contrast-induced nephropathy of coronary heart disease treated by percutaneous coronary intervention in moderate and high-risk population stratified by Mehran score. Angiology. 2022;73(1):33-41. DOI: https://doi.org/10.1177/00033197211015540

Guo Y, Xu X, Xue Y, Zhao C, Zhang X, Cai H. Mehran 2 contrast-associated acute kidney injury risk score: is it applicable to the Asian percutaneous coronary intervention population? Clin Appl Thrombos Hemostas. 2022;28:10760296221116353. DOI: https://doi.org/10.1177/10760296221116353

Zhang X, Zhang P, Yang S, Li W, Men X, Fu N. Preventive effect of trimetazidine on contrast-induced nephropathy undergoing percutaneous coronary intervention in elderly moderate and high-risk diabetics stratified by mehran score. Perfusion. 2021;36(5):491-500. DOI: https://doi.org/10.1177/0267659120952057

Abdulsalam N. External multicenter validation of the mehran risk score for contrast induced acute kidney injury. Int Arch Cardiovasc Dis. 2021;5:048. DOI: https://doi.org/10.23937/2643-3966/1710048

Samir A, Gabra W, Alhossary H, Bakhoum S. Predictive value of CHA2DS2VASC score for contrast-induced nephropathy after primary percutaneous coronary intervention for patients presenting with acute ST-segment elevation myocardial infarction. Egypt Heart J. 2023;75(1):52. DOI: https://doi.org/10.1186/s43044-023-00378-x

Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, et al. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet. 2021;398(10315):1974-83. DOI: https://doi.org/10.1016/S0140-6736(21)02326-6

Yuan Y, Qiu H, Hu X, Zhang J, Wu Y, Qiao S, et al. A risk score model of contrast-induced acute kidney injury in patients with emergency percutaneous coronary interventions. Front Cardiovasc Med. 2022;9:989243. DOI: https://doi.org/10.3389/fcvm.2022.989243

Kumar R, Khan KA, Rai L, Solangi BA, Ammar A, Khan MN, et al. Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions. IJC Heart Vasculat. 2021;37:100905. DOI: https://doi.org/10.1016/j.ijcha.2021.100905

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(7):1393-9. DOI: https://doi.org/10.1016/S0735-1097(04)01445-7

Kaya A, Karataş A, Kaya Y, Düğeroğlu H, Dereli S, Bayramoğlu A. A new and simple risk predictor of contrast‐induced nephropathy in patients undergoing primary percutaneous coronary intervention: TIMI Risk Index. Cardiol Res Pract. 2018;2018(1):5908215. DOI: https://doi.org/10.1155/2018/5908215

Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Sparta I, et al. Mehran contrast- induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevationmyocardial infarction. Circulat Cardiovasc Intervent. 2010;3:491-8. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.110.955310

Lucreziotti S, Centola M, Salerno-Uriarte D, Ponticelli G, Battezzati PM, Castini D, et al. Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction. Int J Cardiol. 2014;174(1):37-42. DOI: https://doi.org/10.1016/j.ijcard.2014.03.087

Caspi O, Habib M, Cohen Y, Kerner A, Roguin A, Abergel E, et al. Acute kidney injury after primary angioplasty: is contrast‐induced nephropathy the culprit? J Am Heart Assoc. 2017;6(6):e005715. DOI: https://doi.org/10.1161/JAHA.117.005715

Andò G, De Gregorio C, Morabito G, Trio O, Saporito F, Oreto G. Renal function–adjusted contrast volume redefines the baseline estimation of contrast-induced acute kidney injury risk in patients undergoing primary percutaneous coronary intervention. Circulat Cardiovasc Intervent. 2014;7(4):465-72. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.114.001545

Santos PR, Neto JDC, Plácido F, Arcanjo N, Carneiro RJK, de Carvalho RC, Cet al. Contrast-induced nephropathy after primary angioplasty for acute myocardial infarction. Brazil J Nephrol 2015;37(4):439-45. DOI: https://doi.org/10.5935/0101-2800.20150070

Channappagoudra P, Nath R, Pandit N. Contrast induced nephropathy in acute STEMI patients undergoing primary PCI and its correlation with volume of contrast and duration of symptoms. Int J Curr Res. 2016;8(04):29789-93.

Marenzi G, Cosentino N, Werba JP, Tedesco CC, Veglia F, Bartorelli AL. A metaanalysis of randomized controlled trials on statins for the prevention of contrast induced acute kidney injury in patients with and without acute coronary syndromes. Int J Cardiol. 2015;183:47-53. DOI: https://doi.org/10.1016/j.ijcard.2015.01.046

Ivanes F, Isorni MA, Halimib JM, Fauchiera L, Etiennea CS, Babutya D, et al. Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty. Arch Cardiovasc Dis. 2014;107:424-32. DOI: https://doi.org/10.1016/j.acvd.2014.05.008

Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Genereux P, et al. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J. 2014;35(23):1533-40. DOI: https://doi.org/10.1093/eurheartj/ehu063

Lin K, Zheng W, Bei W, Chen S, Islam SMS, Liu Y, et al. A novel risk score model for prediction of contrast-induced nephropathy after emergent percutaneous coronary intervention. Int J Cardiol. 2017;230:402-12. DOI: https://doi.org/10.1016/j.ijcard.2016.12.095