Mehran_Score_Contrast_induced_Nephropathy_guideline v.1

Mehran Score for Post-PCI Contrast Nephropathy

Maryam Razavi

maryam.razavi@cambio.se

CambioCDS

To predict risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).

Use in patients undergoing PCI. Variables and assigned points: - Hypotension: No=0, Yes=5 (Systolic blood pressure <80 mmHg for at least 1 hour requiring inotropic support with medications or intra-aortic balloon pump within 24 hours periprocedurally.) - Intra-aortic balloon pump: No=0, Yes=5 - Congestive heart failure: No=0, Yes=5 (CHF class III/IV by New York Heart Association Classification and/or history of pulmonary edema.) - Age >75 years: No=0, Yes=4 - Anemia: No=0, Yes=3 (Baseline hematocrit value <39% for men and <36% for women.) - Diabetes: No=0, Yes=3 - Contrast media volume: 1 point per 100 mL contrast - eGFR, mL/min/1.73 m2: ≥60=0, 40 to <60=2, 20 to <40=4, <20=6 Note: the original study includes serum creatinine (as a dichotomous variable) as an alternative to eGFR, and adds 4 points for Cr >1.5 mg/dL. We have chosen to use eGFR in this calculator as it tends to be a more accurate measure of renal function than creatinine alone. Formula: Addition of the selected points. Interpretation: CIN Risk Score ≤5= Risk of post-PCI CIN: Any CIN=7.5% and CIN requiring dialysis=0.04% CIN Risk Score 6-10 = Risk of post-PCI CIN: Any CIN=14.0% and CIN requiring dialysis=0.12% CIN Risk Score 11-15 = Risk of post-PCI CIN: Any CIN=26.1% and CIN requiring dialysis=1.09% CIN Risk Score ≥16 = Risk of post-PCI CIN: Any CIN=57.3% and CIN requiring dialysis=12.6%

Not to use in patients with pre-existing end-stage renal disease on dialysis or patients with contrast exposure within 1 week of the index procedure.

1. Mehran R, Aymong ED, Nikolsky E, 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. 2. Wi J, Ko YG, Shin DH, et al. Prediction of Contrast-Induced Nephropathy With Persistent Renal Dysfunction and Adverse Long-term Outcomes in Patients With Acute Myocardial Infarction Using the Mehran Risk Score. Clin Cardiol. 2013;36(1):46-53. 3. Sgura FA, Bertelli L, Monopoli D, 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. 4. Raingruber B, Kirkland-walsh H, Chahon N, Kellermann M. Using the Mehran risk scoring tool to predict risk for contrast medium-induced nephropathy in patients undergoing percutaneous angiography. Crit Care Nurse. 2011;31(1):e17-22. 5. Abellás-sequeiros RA, Raposeiras-roubín S, Abu-assi E, et al. Mehran contrast nephropathy risk score: Is it still useful 10 years later?. J Cardiol. 2016;67(3):262-7.

OBSERVATION.mehran_score.v0