Hager Ibrahim Allam, Hesham Mohammed Aboul-Enein, Ali Ibrahim Attia and Mohamed Samir Elshazly
Background: CIN, a significant complication occurring post-PCI, particularly affects individuals with chronic total occlusions. It is crucial to identify people at risk for CIN early on in order to improve clinical outcomes and save medical expenses. Patients with atrial fibrillation have their embolic risk assessed using the CHA2DS2-VASC score and has demonstrated potential in forecasting various cardiovascular incidents. Nevertheless, its applicability in predicting CIN among CTO patients undergoing PCI has not been thoroughly investigated.
Aim: This study aims to evaluate the predictive power of the CHA2DS2-VASC score for the incidence of CIN in patients undergoing CTO PCI.
Methods: 60 CTO patients underwent PCI at Benha University Hospital in a prospective observational study. Each participant's CHA2DS2-VASC score was determined prior to the intervention. Those with a significant rise in serum creatinine (≥0.5 mg/dL or a 25% elevation) within 48 hours of PCI were assigned to the CIN group, whereas those without such an increase were assigned to the non-CIN group. To investigate the correlation between CHA2DS2-VASC scores and CIN, logistic regression was employed. The ROC curve was used to evaluate the score's predictive potential.
Results: 18 (30%) of the 60 patients developed CIN post PCI. The median CHA2DS2-VASC Risk Score was 1.93 (ranging from 1 to 5). With a significantly higher median CHA2DS2-VASC Score (4.0) than the non-CIN group (2.5), a p-value of 0.001 suggested increased cardiovascular risk for individuals with CIN, while a CHA2DS2-VASC Risk cut-off value of ≥4 provided the highest diagnostic accuracy, having an area under the curve (AUC) of 0.842, a specificity of 66.7%, and a sensitivity of 83.3%.
Conclusion: Among patients having PCI for chronic complete occlusions, the CHA2DS2-VASC score strongly predicts contrast-induced nephropathy. Due to its straightforward calculation and robust predictive power, the CHA2DS2-VASC score can be seamlessly incorporated into clinical practice for assessing pre-procedural risks and informing preventive measures. To validate these findings in more extensive, multi-center investigations, more investigation is required.
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