Association between CHA2DS2-VASc score and Contrast- Induced Nephropathy in Patients with Chronic Coronary Syndromes after Percutaneous Coronary Intervention

Abstract

Background: Contrast-induced nephropathy (CIN) causes the third most hospital-related acute renal damage. Flexible percutaneous coronary intervention (PCI) is risky. CIN can occur in almost 50% of PCI patients. As this consequence increases patient morbidity and mortality beyond PCI. Thus, early CIN risk detection and prediction are essential to patient care. CHA2DS2-VASc, a simple risk assessment tool, can complement the more advanced CIN risk score model.

Objective: To a find out the association between CHA2DS2-VASc score and contrast induced nephropathy after percutaneous coronary intervention in patients with chronic coronary syndromes.

Methods: This cross-sectional observational study was conducted at the Department of Cardiology at National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period from May, 2020 to April, 2021. A total 100 patients with chronic coronary syndromes undergoing PCI were enrolled in this study. CHA2DS2- VASc score was calculated for each patient. These patients were divided into two groups as Group I (score < 4) and Group II (score ≥ 4). After PCI was done, patients were followed up to see development of contrast induced nephropathy. CIN was defined as increase in serum creatinine level (≥ 0.5mg/dl) or relative increase (≥25%) increase from baseline within 24 to 48 hours after PCI.

Results: The mean ±SD CHA2DS2-VASc score was 3.23 ± 1.14. Most of the subjects (41 out of 100) belonged to 51-60 years’ age group. Males were prevalent than females. No significant difference was noted regarding history of dyslipidaemia, smoking, family history of CAD between group I and group II except for DM, hypertension and lower ejection fraction. DM and hypertension were more frequent in group II than group I (28 % vs 56%, p=0.005) and (40 % vs 54%, p= 0.04) respectively. LVEF was lower in group II than group I (54.621% vs 48.06%, p = 0.001). Both pre and post catheterization serum creatinine were significantly higher in group II compared to group I. CIN was significantly higher in group I (16%) than group II (24%). In multivariate analysis demonstrated CHA2DS2- VASc score of ≥4 to be an independent predictor of contrast induced nephropathy (CIN).

Conclusion: In patients with chronic coronary syndromes undergoing percutaneous coronary intervention CHA2DS2-VASc score may be used as a novel, simple, and a sensitive diagnostic tool for the prediction of contrast induced nephropathy (CIN).