TIMI RISK INDEX, A SIMPLE TOOL IN EMERGENCY PERCUTANEOUS REVASCULARIZATION FOR THE PREDICTION OF CONTRAST INDUCED NEPHROPATHY

Authors

  • Rajesh Kumar National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Aziz-ur Rehman Memon National Institute of Cardiovascular Diseases
  • Abdul Hakeem Shaikh National Institute of Cardiovascular Diseases
  • Zille Huma National Institute of Cardiovascular Diseases
  • Vinesh Kumar National Institute of Cardiovascular Diseases
  • Afzal Hussain National Institute of Cardiovascular Diseases
  • Jawaid Akbar Sial National Institute of Cardiovascular Diseases
  • Tahir Saghir National Institute of Cardiovascular Diseases
  • Abdul Samad Achakzai National Institute of Cardiovascular Diseases
  • Musa Karim National Institute of Cardiovascular Diseases

DOI:

https://doi.org/10.55519/JAMC-04-10733

Keywords:

TIMI Risk Index, primary percutaneous coronary intervention, contrast induced nephropathy

Abstract

Background: Contrast induced nephropathy (CIN) is a common complication seen after primary percutaneous coronary intervention (PCI) which can contribute to increased morbidity and mortality in patients of acute ST elevation myocardial infarction (STEMI). Aim of this study was to validate the TIMI Risk Index (TRI) for the risk stratification of CIN in patients undergone primary PCI. Methods: Consecutive patients of STEMI undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patients with history of any PCI and chronic kidney diseases were excluded from this study. TRI was calculated using the formula “” and post-procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. Results: A total of 507 patients were included in this study out of which 82.2% were males and 17.8% were females. In total 8.7% (44) patients developed CIN. In the receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) for TRI was found to be 0.717, [0.649–0.758] for the prediction of CIN. Sensitive, specificity, positive predictive value and negative predictive value of TRI >22.8 to predict the development of CIN were 59.09%, 76.69%, 19.55% and 95.19% respectively. Conclusion: TIMI risk index is and easy to calculate and readily accessible score which has good predictive value to evaluate the risk of CIN in primary PCI setting.

References

Fox CS, Muntner P, Chen AY, Alexander KP, Roe MT, Wiviott SD. Short-term outcomes of acute myocardial infarction in patients with acute kidney injury: a report from the national cardiovascular data registry. Circulation 2012;125(3):497–504.

Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2004;44(9):1780–5.

Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P, et al. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 2014;35(23):1533–40.

Marenzi G, Assanelli E, Campodonico J, De Metrio M, Lauri G, Marana I, et al. Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission. Crit Care Med 2010;38(2):438–44.

Cruz DN, Goh CY, Marenzi G, Corradi V, Ronco C, Perazella MA. Renal replacement therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Med 2012;125(1):66–78.e3.

Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med 1983;74(2):243–8.

Investigators ACT. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation 2011;124(11):1250–9.

Bolognese L, Falsini G, Schwenke C, Grotti S, Limbruno U, Liistro F, et al. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial). Am J Cardiol 2012;109(1):67–74.

Kume K, Yasuoka Y, Adachi H, Noda Y, Hattori S, Araki R, et al. Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med 2013;14(5):253–7.

Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 2014;7(1):1–9.

McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, et al. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 2006;98(6):5–13.

Valle JA, McCoy LA, Maddox TM, Rumsfeld JS, Ho PM, Casserly IP, et al. Longitudinal risk of adverse events in patients with acute kidney injury after percutaneous coronary intervention: insights from the National Cardiovascular Data Registry. Circ Cardiovasc Interv 2017;10(4):e004439.

Caspi O, Habib M, Cohen Y, Kerner A, Roguin A, Abergel E, et al. Acute kidney injury after primary angioplasty: is contrast‐induced nephropathy the culprit? J Am Heart Assoc 2017;6(6):e005715.

He H, Chen XR, Chen YQ, Niu TS, Liao YM. Prevalence and predictors of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI): A meta-analysis. J Interv Cardiol 2019;2019:2750173.

Khalfallah M, Allaithy A, Maria DA. Incidence, Predictors and Outcomes of Contrast Induced Nephropathy in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Global Heart 2021;16(1):57.

Chaudhary AK, Pathak V, Kunal S, Shukla S, Pathak P. CHA2DS2-VASc score as a novel predictor for contrast-induced nephropathy after percutaneous coronary intervention in acute coronary syndrome. Indian Heart J 2019;71(4):303–8.

Andò G, Morabito G, de Gregorio C, Trio O, Saporito F, Oreto G. Age, glomerular filtration rate, ejection fraction, and the AGEF score predict contrast‐induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2013;82(6):878–85.

Capodanno D, Ministeri M, Dipasqua F, Dalessandro V, Cumbo S, Gargiulo G, et al. Risk prediction of contrast-induced nephropathy by ACEF score in patients undergoing coronary catheterization. J Cardiovasc Med 2016;17(7):524–9.

Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Spartà I, et al. Mehran contrast-induced nephropathy risk score predicts short-and long-term clinical outcomes in patients with ST-elevation–myocardial infarction. Circ Cardiovasc Interv 2010;3(5):491–8.

Wiviott SD, Morrow DA, Frederick PD, Giugliano RP, Gibson CM, McCabe CH, et al. Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and-4: a simple index that predicts mortality in ST-segment elevation myocardial infarction. J Am Coll Cardiol 2004;44(4):783–9.

Parfrey P. The clinical epidemiology of contrast-induced nephropathy. Cardiovasc Interv Radiol 2005;28(2):S3–11.

Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39(5):930–6.

Azzalini L, Poletti E, Lombardo F, Laricchia A, Beneduce A, Moscardelli S, et al. Risk of contrast-induced nephropathy in patients undergoing complex percutaneous coronary intervention. Int J Cardiol 2019;290:59–63.

Demir OM, Lombardo F, Poletti E, Laricchia A, Beneduce A, Maccagni D, et al. Contrast-induced nephropathy after percutaneous coronary intervention for chronic total occlusion versus non-occlusive coronary artery disease. Am J Cardiol 2018;122(11):1837–42.

Kaya A, Karataş A, Kaya Y, Düğeroğlu H, Dereli S, Bayramoğlu A. A new and simple risk predictor of contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention: TIMI risk index. Cardiol Res Pract 2018;2018:5908215.

Amin AP, Salisbury AC, McCullough PA, Gosch K, Spertus JA, Venkitachalam L, et al. Trends in the incidence of acute kidney injury in patients hospitalized with acute myocardial infarction. Arch Intern Med 2012;172(3):246–53.

Kurtul A, Yarlioglues M, Duran M. Predictive value of CHA2DS2-VASC score for contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol 2017;119(6):819–25.

Kurtul A, Yarlioglues M, Duran M, Murat SN. Association of neutrophil-to-lymphocyte ratio with contrast-induced nephropathy in patients with non-ST-elevation acute coronary syndrome treated with percutaneous coronary intervention. Heart Lung Circ 2016;25(7):683–90.

Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004;44(7):1393–9.

Goriki Y, Tanaka A, Nishihira K, Kuriyama N, Shibata Y, Node K. A Novel Prediction Model of Acute Kidney Injury Based on Combined Blood Variables in STEMI. JACC Asia 2021;1(3):372–81.

Kiris T, Avci E, Celik A. Association of the blood urea nitrogen-to-left ventricular ejection fraction ratio with contrast-induced nephropathy in patients with acute coronary syndrome who underwent percutaneous coronary intervention. Int Urol Nephrol 2019;51(3):475–81.

Victor SM, Gnanaraj A, VijayaKumar S, Deshmukh R, Kandasamy M, Janakiraman E, et al. Risk scoring system to predict contrast induced nephropathy following percutaneous coronary intervention. Indian Heart J 2014;66(5):517–24.

Wang J, Zhang C, Liu Z, Bai Y. Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis. J Int Med Res 2021;49(4):03000605211005972.

Bao L, Bo J, Jin B, Xiong N, Ni H, Li J, et al. Clinical Features of CINin ChineseVery Elderly Patients Undergoing Coronary Angiography Procedure With Hydration Treatment: A Three-Center, Prospective Study. Int J Gerontol 2018;12(3):196–9.

Ghazal KH, Abdelghany TMM, Hamed KMS, Eldamahoury AS. Blood urea nitrogen to left ventricular ejection fraction ratio and TIMI risk index as predictors for contrast-induced nephropathy in patients with acute coronary syndrome. Eur J Mol Clin Med 2021;8(2):2615–27.

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Published

2022-09-27

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