Key result
A Mehran Risk Score ≥6.5 was an independent predictor of contrast-induced nephropathy with an adjusted OR of 2.54, but its low positive predictive value of 21.2% suggests a need for modification to improve clinical utility.
Why the study?
Contrast induced nephropathy is a common complication associated with increased morbidity and mortality after primary PCI, motivating validation of the Mehran Risk Score for CIN risk stratification in this population.
Does the Mehran Risk Score accurately predict contrast-induced nephropathy in patients undergoing primary PCI?
Cross-Sectional (n=547)
No
Does the Mehran Risk Score accurately predict contrast-induced nephropathy in patients undergoing primary PCI?
Odds Ratio: 2.54 (95% CI 1.37–4.69)
Absolute Event Rate: 21.2% vs 6.5%
p-value: p=0.003
The Mehran Risk Score provides good discrimination for predicting contrast-induced nephropathy after primary PCI, though its low positive predictive value indicates a need for score modification in the modern era.
Cautions against sole reliance on Mehran score for nephropathy prediction; leaves open need for refined thresholds in validation studies.
Objectives: Contrast induced nephropathy (CIN) is a common complication and found to be associated with increased morbidity and mortality after primary percutaneous coronary intervention (PCI). The objective of this study was to validate the Mehran Risk Score (MRS) for the risk stratification of CIN in patients undergone primary PCI. Methodology: A cohort of consecutive patients undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patents history of any PCI, and chronic kidney diseases were excluded from this study. MRS was calculated at baseline and post procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. Results: A total of 547 patients were included, of which 79.3%(434) were male. CIN after primary PCI was observed in 62(11.3%) patients. The area under the curve (AUC) for the MRS was 0.712 [0.641 to 0.783]. Cut-off value of ≥6.5 had sensitivity of 61.3% [48.1%-73.4%] with positive predictive value of 21.2% [17.5%-25.6%] and specificity of 70.9% [66.7%-74.9%] with negative predictive value of 93.5% [91.3%-95.2%]. MRS ≥6.5 was found to be an independent predictor on multivariable analysis with adjusted odds ratios (OR) of 3.86 [2.23-6.68] along with multi-vessel diseases with OR of 2.31 [1.27-4.19]. Conclusion: MRS has shown to have a good discriminating power. However low positive predictive value of the optimal cutoff value of ≥6.5 for prediction of CIN suggests need of modification to the MRS to improve its clinical utility in the modern era of primary PCI.
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Kumar et al. (2022) conducted a cross-sectional in ST-segment elevation myocardial infarction (STEMI) (n=547). Mehran Risk Score ≥6.5 vs. Mehran Risk Score <6.5 was evaluated on Contrast-induced nephropathy (CIN) defined as post-procedure serum creatinine level increase of either 25% or 0.5 mg/dL (OR 2.54, 95% CI 1.37-4.69, p=0.003). A Mehran Risk Score ≥6.5 was an independent predictor of contrast-induced nephropathy with an adjusted OR of 2.54, but its low positive predictive value of 21.2% suggests a need for modification to improve clinical utility.
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