Key result
Adding fasting pre-procedural glycemia to the Mehran score significantly enhanced the prediction of contrast-induced acute kidney injury compared to the Mehran score alone (AUC 0.749 vs 0.673).
Why the study?
Abnormal fasting pre-procedural glycemia is a modifiable risk factor for CI-AKI not included in current risk models, and whether adding it to the Mehran score improves prediction of CI-AKI after PCI is unknown.
Does adding fasting pre-procedural glycemia to the Mehran score improve the prediction of contrast-induced acute kidney injury in patients undergoing PCI?
Cohort (n=1,344)
No
Does adding fasting pre-procedural glycemia to the Mehran score improve the prediction of contrast-induced acute kidney injury in patients undergoing PCI?
Effect estimate: AUC 0.749 (95% CI 0.662-0.836)
Absolute Event Rate: 0.749% vs 0.673%
p-value: p=0.0016
Adding fasting pre-procedural glycemia to the Mehran score (creating the GlyMehr score) significantly enhances the ability to predict contrast-induced acute kidney injury in patients undergoing PCI.
May refine contrast-induced AKI risk stratification; leaves open prospective validation before clinical adoption.
Background: The Mehran score is the most widely accepted tool for predicting contrast-induced acute kidney injury (CI-AKI), a major complication of percutaneous coronary intervention (PCI). Similarly, abnormal fasting pre-procedural glycemia (FPG) represents a modifiable risk factor for CI-AKI, but it is not included in current risk models for CI-AKI prediction. We sought to analyze whether adding FPG to the Mehran score improves its ability to predict CI-AKI following PCI. Methods: We analyzed 671 consecutive patients undergoing PCI (age 69 [63,75] years, 23% females), regardless of their diabetic status, to derive a revised Mehran score obtained by including FPG in the original Mehran score (Derivation Cohort). The new risk model (GlyMehr) was externally validated in 673 consecutive patients (Validation Cohort) (age 69 [62,76] years, 21% females). Results: In the Derivation Cohort, both FPG and the original Mehran score predicted CI-AKI (AUC 0.703 and 0.673, respectively). The GlyMehr score showed a better predictive ability when compared with the Mehran score both in the Derivation Cohort (AUC 0.749, 95%CI 0.662-0.836; p=0.0016) and the Validation Cohort (AUC 0.848, 95%CI, 0.792–0.903; p=0.0008). In the overall population (n=1344), the GlyMehr score confirmed its independent and incremental predictive ability regardless of diabetic status (p≤0.0034) or unstable/stable coronary syndromes (p≤0.0272). Conclusions: Adding FPG to the Mehran score significantly enhances our ability to predict CI-AKI. The GlyMehr score may contribute to improve the clinical management of patients undergoing PCI by identifying those at high risk of CI-AKI and potentially detecting modifiable risk factors.
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Nusca et al. (2020) conducted a cohort in Patients undergoing percutaneous coronary intervention (n=1,344). GlyMehr score (Mehran score + fasting pre-procedural glycemia) vs. Mehran score was evaluated on Prediction of contrast-induced acute kidney injury (AUC) (AUC 0.749, 95% CI 0.662-0.836, p=0.0016). Adding fasting pre-procedural glycemia to the Mehran score significantly enhanced the prediction of contrast-induced acute kidney injury compared to the Mehran score alone (AUC 0.749 vs 0.673).
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