Key result
An 8-variable clinical scoring system (pPCI-AKI score) predicted acute kidney injury in STEMI patients after emergency primary PCI with an area under the ROC curve of 0.78 (95% CI 0.75-0.82).
Why the study?
Existing scores to predict post-procedural AKI rely on obsolete definitions, creating a need for an updated prediction score in patients with STEMI undergoing emergency primary PCI.
Can a clinical scoring system accurately predict acute kidney injury in patients with STEMI undergoing emergency primary PCI?
Cohort (n=1,617)
No
Can a clinical scoring system accurately predict acute kidney injury in patients with STEMI undergoing emergency primary PCI?
Effect estimate: AUC 0.78 (95% CI 0.75-0.82)
A newly developed clinical score using 8 routine variables provides acceptable predictive performance for acute kidney injury following primary PCI in STEMI patients.
Updated AKI prediction score for STEMI may refine risk stratification; leaves open need for prospective validation before adoption.
Acute kidney injury (AKI) after a coronary intervention is common in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with significant morbidity and mortality. Several scores have been developed to predict post-procedural AKI over the years. However, the AKI definitions have also evolved, which causes the definitions used in the past to be obsolete. We aimed to develop a prediction score for AKI in patients with STEMI requiring emergency primary percutaneous coronary intervention (pPCI). This study was based on a retrospective cohort of Thai patients with STEMI who underwent pPCI at the Central Chest Institute of Thailand from December 2014 to September 2019. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL from baseline within 48 h after pPCI. Logistic regression was used for modeling. A total of 1617 patients were included. Of these, 195 patients had AKI (12.1%). Eight significant predictors were identified: age, baseline creatinine, left ventricular ejection fraction (LVEF) < 40%, multi-vessel pPCI, treated with thrombus aspiration, inserted intra-aortic balloon pump (IABP), pre- and intra-procedural cardiogenic shock, and congestive heart failure. The score showed an area under the receiver operating characteristic curve of 0.78 (95% CI 0.75, 0.82) and was well-calibrated. The pPCI-AKI score showed an acceptable predictive performance and was potentially useful to help interventionists stratify the patients and provide optimal preventive management.
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Kaladee et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) requiring emergency primary percutaneous coronary intervention (pPCI) (n=1,617). 8-variable clinical prediction score (pPCI-AKI score) was evaluated on Acute kidney injury (increase in serum creatinine ≥ 0.3 mg/dL from baseline within 48 h after pPCI) (AUC 0.78, 95% CI 0.75-0.82). An 8-variable clinical scoring system (pPCI-AKI score) predicted acute kidney injury in STEMI patients after emergency primary PCI with an area under the ROC curve of 0.78 (95% CI 0.75-0.82).
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