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Prediction of Contrast-Induced Nephropathy With Persistent Renal Dysfunction and Adverse Long-term Outcomes in Patients With Acute Myocardial Infarction Using the Mehran Risk Score

Authors
 Jin Wi  ;  Young-Guk Ko  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Donghoon Choi  ;  Jong-Won Ha  ;  Myeong-Ki Hong  ;  Yangsoo Jang 
Citation
 CLINICAL CARDIOLOGY, Vol.36(1) : 46-53, 2013 
Journal Title
 CLINICAL CARDIOLOGY 
ISSN
 0160-9289 
Issue Date
2013
MeSH
Angioplasty, Balloon, Coronary ; Contrast Media/adverse effects* ; Coronary Angiography/adverse effects* ; Coronary Angiography/methods ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney Diseases/chemically induced* ; Kidney Diseases/epidemiology ; Kidney Diseases/physiopathology ; Myocardial Infarction/diagnostic imaging* ; Myocardial Infarction/therapy ; Prognosis ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Assessment* ; Risk Factors ; Time Factors
Keywords
Angioplasty, Balloon, Coronary ; Contrast Media/adverse effects* ; Coronary Angiography/adverse effects* ; Coronary Angiography/methods ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney Diseases/chemically induced* ; Kidney Diseases/epidemiology ; Kidney Diseases/physiopathology ; Myocardial Infarction/diagnostic imaging* ; Myocardial Infarction/therapy ; Prognosis ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Assessment* ; Risk Factors ; Time Factors
Abstract
BACKGROUND: Contrast-induced nephropathy (CIN) has been generally considered to be transient and associated with unfavorable clinical outcomes. HYPOTHESIS: The aim of this study was to investigate whether Mehran risk score could predict CIN with persistent renal dysfunction and long-term clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). METHODS: We analyzed the clinical data of 1041 AMI patients. The primary end point was defined as major adverse cardiovascular and cerebrovascular event (MACCE) including death, reinfarction, target vessel revascularization, heart failure requiring hospital admission, and stroke. Patients were categorized into 4 groups according to risk scores: low (≤ 5, n = 596), moderate (6-10, n = 265), high (11-15, n = 111), and very high (≥16, n = 69). RESULTS: Among the 148 patients (14.2%) who developed CIN, persistent renal dysfunction was observed in 68 patients. Presence in high- or very high-risk groups was the most important independent risk factor of CIN with persistent renal dysfunction (odds ratio: 3.35, 95 confidence interval [CI]: 1.89-5.92, P < 0.001). Furthermore, patients in higher-risk groups experienced significantly more MACCE and mortality 2 years after PCI. Using multivariate analysis, significant increase in the hazard ratio (HR) for MACCE was noted in moderate- (HR: 1.40, 95% CI: 0.97-2.03, P = 0.075), high- (HR 1.96, 95% CI: 1.22-3.15, P = 0.006), and very high-risk (HR 2.40, 95% CI: 1.36-4.21, p = 0.002) groups, compared with the low-risk group. The very high-risk group had approximately 6-fold increase in mortality over the low-risk group (HR: 6.22, 95% CI: 2.77-13.95, P < 0.001). CONCLUSIONS: Mehran risk score predicted CIN with persistent renal dysfunction and long-term clinical outcomes in patients with AMI.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/clc.22060/abstract
DOI
10.1002/clc.22060
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Wi, Jin(위진) ORCID logo https://orcid.org/0000-0003-0655-5130
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87616
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