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Zwolle score as a predictor of contrast-induced nephropathy after primary angioplasty
Session:
Posters 4 - Écran 8 - Cardiologia de Intervenção
Speaker:
Diogo Brás
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Posters
FP Number:
---
Authors:
Diogo Brás; Mafalda Carrington; Rui Azevedo Guerreiro; Antonio; Kisa Hyde Congo; Pedro Semedo; Bruno Cordeiro Piçarra; José Eduardo Aguiar
Abstract
<p>BACKGROUND</p> <p>Contrast-induced nephropathy is an important complication after invasive cardiac procedures, as it is associated with short- and long-term morbidity/mortality, as well as longer hospitalizations and higher hospital costs.</p> <p>The Zwolle primary PCI index is a risk score that has been used to identify low-risk patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI (PPCI). We questioned whether the this score, with simple and practical components that might be calculable in the Catheterization Laboratory during primary PCI, could predict the development of Contrast-Induced Nephropathy.</p> <p> </p> <p>PURPOSE</p> <p>The authors intend to study the Zwolle score (ZS) as a predictor of contrast-induced nephropathy (CIN).</p> <p> </p> <p>METHODS</p> <p>This retrospective study is composed of a sample of 225 patients that were admitted in our hospital with STEMI that underwent PPCI.</p> <p>The ZS (16 points (p) total) is characterized by:</p> <p>-Killip 1: 0p; Killip 2: 4p; Killip 3-4: 9p</p> <p>-TIMI 3 flow post: 0p; TIMI 2: 1p; TIMI 0-1: 2p</p> <p>-Age <60: 0p; ≥60: 2p</p> <p>-3-vessel disease: 1p</p> <p>-Anterior MI: 1p</p> <p>-Ischaemia time >4h: 1p</p> <p> </p> <p>The variable CIN is defined as an increase of 25% or 0.5mg/dL relative to baseline serum creatinine in the first 72 hours after contrast administration.</p> <p>After population characterization, we have performed a ROC curve analysis between the outcome CIN and ZS, reporting AUC, optimal c-statistic and its epidemiological data.</p> <p>We also have performed a multivariate analysis reporting OR with plausible variables.</p> <p> </p> <p>RESULTS</p> <p>The sample mean age was 63,4 ± 14,7, and it is composed by 79,5% of males. The majority of patients presented Killip Class I (83,1%). More than half of the patients presented anterior MI (51,3%). The mean serum creatinine at admission was 1 ± 0.4md/dL.</p> <p>The mean ZS was 3,8 ± 3,2 points, and 21,3% of the included patients presented CIN.</p> <p>The ROC curve analysis between CIN and ZS revealed an c-statistic of 0.824 and an Youden index of 3.5p (optimal cut-off point: specificity 68%, sensitivity 84%, negative predicting value 94%, positive predicting value 42% and diagnostic accuracy of 72%).</p> <p>We have also performed a multivariate analysis model to test the outcome CIN, which included the variables Killip Class, age and ZS >3.5p. It registered an OR of 8 (95% CI 2,2 – 28,8; p=0.002) for the variable ZS >3.5p. The other variables have not achieved statistical significance.</p> <p> </p> <p>CONCLUSION</p> <p>We conclude that the ZS is a good test to predict CIN in our population of patients submitted to PPCI. A ZS >3.5 is the optimal cut-off point to predict the studied outcome and represents an increased risk of CIN by 8 times.</p> <p>The calculation of the Zwolle score during PCI could allow the initiation of preventive measures to limit the renal damage associated with this intervention. It can also be used for risk stratification in this population of patients.</p>
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