SIGNIFICANCE OF CANADA ACUTE CORONARY SYNDROME RISK SCORE IN EMERGENCY PERCUTANEOUS REVASCULARIZATION FOR THE PREDICTION OF CONTRAST INDUCED NEPHROPATHY

Authors

  • Ashok Kumar National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
  • Kahkashan Zehra Naqvi National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Shueeta Kumari National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Rajesh Kumar National Institute of Cardiovascular Diseases Karachi, Pakistan
  • Muhammad Tariq Farman Dow University of Health Sciences (DUHS), Karachi, Pakistan
  • Shahid Ahmed National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Samra Kazmi Dow University of Health Sciences, Karachi, Pakistan
  • Muhammad Murtaza National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Omesh Kumar National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Jawaid Akbar Sial National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Tahir Saghir National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan

DOI:

https://doi.org/10.47144/phj.v55i2.2232

Abstract

Objectives: This study was conducted to compare the accuracy of Canada Acute Coronary Syndrome (C-ACS) score against Mehran risk score (MRS) in primary percutaneous coronary intervention (PCI) patients for risk stratification of contrast induced nephropathy (CIN) at a tertiary care cardiac hospital.

Methodology: In this study we included adult patients presented with chief presenting complaint of typical chest pain to emergency department within 12 hours of onset of symptoms, diagnosed with ST-segment elevation myocardial infarction (STEMI) and taken to the catheterization laboratory for primary PCI. Two scores MRS and C-ACS were computed and CIN was defined based on the variations in creatinine level, absolute 0.5 mg/dL or relative 25% increase at 48-72 hours.

Results: Study included a total of 593 patients with mean age of 52.22±11.1 years and 488(82.3%) were male patients. A total of 53(8.9%) patients developed CIN after primary PCI. The area under the curve (AUC) was 0.745 [0.675-0.815] and 0. 647 [0.560-0.733] for MRS and C-ACS score respectively. The threshold value C-ACS ≥ 1 has sensitivity of 47.2% [33.3%-61.4%] and specificity of 80.2% [76.6%-83.5%]. Similarly, MRS ≥6.5 has sensitivity of 64.2% [49.8%-76.9%] and specificity of 75% [71.1%-78.6%].

Conclusion: C-ACS score is found to be less sensitive but more specific in identifying patients at high risk of CIN. Predictive value of C-ACS was observed to be lower than that of MRS. In the tradeoff of simplicity and accuracy, clinicians may consider accuracy and prefer MRS over C-ACS for the risk stratification of CIN.

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Published

2022-07-05

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Original Article