CHA2DS2-VASc, a Simple Clinical Score Expanding Its Boundaries to Predict Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Interventions

Rajesh Kumar; Mahesh Kumar Batra; Sanam Khowaja; Ali Ammar; Ashok Kumar; Jehangir Ali Shah; Jawaid Akbar Sial; Tahir Saghir; Musa Karim

doi:10.2147/IJNRD.S347303

CHA₂DS₂-VASc, a Simple Clinical Score Expanding Its Boundaries to Predict Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Interventions

Int J Nephrol Renovasc Dis. 2021 Dec 31:14:495-504. doi: 10.2147/IJNRD.S347303. eCollection 2021.

Authors

Rajesh Kumar¹, Mahesh Kumar Batra¹, Sanam Khowaja¹, Ali Ammar¹, Ashok Kumar¹, Jehangir Ali Shah¹, Jawaid Akbar Sial¹, Tahir Saghir¹, Musa Karim²

Affiliations

¹ Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
² Research Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

Abstract

Objective: Promising results of CHA₂DS₂-VASc score have been reported for the prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, data of its predictive strength in the context of primary PCI are not available. Therefore, in this study, we have assessed predictive value of CHA₂DS₂-VASc score for CI-AKI after primary PCI.

Methods: This analytical cross-sectional study was conducted between January 2021 and June 2021 at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Inclusion criteria of the study was consecutive adult patients who had undergone primary PCI. Baseline CHA₂DS₂-VASc score was calculated, and either a 25% or 0.5 mg/dL increase in post-procedure serum creatinine level as compared to baseline level was categorized as CI-AKI.

Results: A total of 691 patients were included, of which 82.1% (567) were male. CI-AKI after primary PCI was observed in 63 (9.1%) patients, out of which 66.7% (42) of patients had CHA₂DS₂-VASc score of ≥2. The area under the curve (AUC) for the score was 0.725 [0.662 to 0.788] with a sensitivity and specificity of 66.7% [63.1% to 70.2%] and 66.7% [53.7% to 78.1%], respectively, at a cut-off value of ≥2. In multivariable analysis, left ventricular ejection fraction ≤30% and CHA₂DS₂-VASc ≥2 were found to be independent predictors with adjusted odds ratios of 2.19 [1.06-4.5] and 2.13 [1.13-4.01], respectively.

Conclusion: CHA₂DS₂-VASc score has a good predictive value for the prediction of CI-AKI after primary PCI. Criteria of CHA₂DS₂-VASc ≥2 can be used for the risk stratification of CI-AKI after primary PCI.

Keywords: CHA2DS2-VASc score; CI-AKI; CIN; ST elevation myocardial infarction; STEMI; contrast-induced acute kidney injury; contrast-induced nephropathy; percutaneous coronary intervention; primary PCI.