Development and Validation of a Pre-Percutaneous Coronary Intervention Risk Model of Contrast-Induced Acute Kidney Injury With an Integer Scoring System - 28/05/15
, Takayuki Abe, PhD b, Hiroaki Miyata, PhD c, Yohei Numasawa, MD d, Ikuko Ueda, PhD a, Yutaro Nishi, MD e, Kotaro Naito, MD f, Masaru Shibata, MD g, Kentaro Hayashida, MD a, Yuichiro Maekawa, MD a, Akio Kawamura, MD a, Yuji Sato, MD h, Keiichi Fukuda, MD aAbstract |
Previous models for contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) include procedure-related variables in addition to pre-procedural variables. We sought to develop a risk model for CI-AKI based on pre-procedural variables and compare its predictability with a conventional risk model and also to develop an integer score system based on selected variables. A total of 5,936 consecutive PCIs registered in the Japanese Cardiovascular Database were analyzed (derivation cohort, n = 3,957; validation cohort, n = 1,979). CI-AKI was defined as an increase in serum creatinine of 50% or 0.3 mg/dl compared with baseline. From the derivation cohort, 2 different CI-AKI risk models were generated using logistic regression analyses: a pre-procedural model and a conventional model including both pre-procedural and procedure-related variables. The predictabilities of the models were compared by c-statistics. An integer score was assigned to each variable in proportion to each estimated regression coefficient for the final model. In our derivation cohort, the proportion of CI-AKI was 9.0% (n = 358). Predictors for CI-AKI included older age, heart failure, diabetes, previous PCI, hypertension, higher baseline creatinine level, and acute coronary syndrome. Presence of procedure-related complications and insertion of intra-aortic balloon pumping were included as procedure-related variables in the conventional model. Both the conventional model (c-statistics 0.789) and the pre-procedural model (c-statistics 0.799) demonstrated reasonable discrimination. The integer risk-scoring method demonstrated good agreement between the expected and observed risks of CI-AKI in the validation cohort. In conclusion, the pre-procedural risk model for CI-AKI had acceptable discrimination compared with the conventional model and may aid in risk stratification of CI-AKI before PCI.
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Vol 115 - N° 12
P. 1636-1642 - juin 2015 Retour au numéro
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