Precautions for CIN prevention

Oct 13, 2025 by leolavanderia.com.br 136 views

The Relationship Between Cha2DS2-Vasc Scores and Contrast-Induced Nephropathy in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention Procedures

Introduction

Contrast-induced nephropathy (CIN) is a serious complication that can arise after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Despite the success of initial coronary revascularization, the development of CIN can lead to increased morbidity and mortality rates both during treatment in hospitals and in the long term. The Cha2DS2-Vasc score, which is often used to predict bad clinical outcomes, has also been found to be relevant in predicting CIN in AMI patients, regardless of the presence or absence of atrial fibrillation. This study aims to explore the relationship between Cha2DS2-Vasc scores and CIN events in AMI patients who undergo PCI strategies.

Background

CIN is a serious problem that can arise after PCI in patients with AMI. The development of CIN can lead to increased morbidity and mortality rates, both during treatment in hospitals and in the long term. The Cha2DS2-Vasc score, which is often used to predict bad clinical outcomes, has also been found to be relevant in predicting CIN in AMI patients, regardless of the presence or absence of atrial fibrillation. This study aims to explore the relationship between Cha2DS2-Vasc scores and CIN events in AMI patients who undergo PCI strategies.

Methods

A cohort ambisant study was conducted on 40 AMI patients treated in the heart care unit. Cha2DS2-Vasc scores were calculated for each patient. Of the total patients studied, as many as 16 cases (40%) experienced CIN, with an overall prevalence of 18.82%. CIN was defined as an increase in creatinine serum more than 0.5 mg/dl or an increase of more than 25% of the basic value within 24 hours after PCI.

Results

The results of the analysis using the ROC curve showed that the Cha2DS2-Vasc score threshold in predicting CIN was more than 3, with a sensitivity of 56.25% and specificity of 87.5% (AUC 0.698, 95%: CI 1,460-6,163, P = 0.003). There was a significant association between this score and the incidence of CIN (R² 0.485). Through multivariate analysis, it was also found that the hemoglobin level below 12 mg/dL functions as an independent CIN predictor with a risk ratio (RR) of 3.44 (95%: CI 1,816-6,532, P <0.001).

Discussion

The conclusion of this study shows that the Cha2DS2-Vasc score is positively related to the CIN event. Therefore, this score can be used as a simple and reliable tool to predict CIN in AMI patients undergoing PCI. Success in managing AMI patients through PCI is very dependent on the ability to predict complications that may occur post-procedures, one of which is CIN. This shows that, although PCI can help restore blood flow to the heart, the risk of kidney damage due to contrast exposure remains. Therefore, the use of Cha2DS2-Vasc scores as a prediction tool provides significant benefits in clinical practice, especially in identifying patients at high risk of experiencing CIN.

Conclusion

CIN can increase maintenance costs and extend the patient's inpatient period. By knowing the existing risks, the doctor can take precautions, such as the right hydration before and after the procedure or considering the use of alternative contrast agents that have low potential in triggering kidney damage. In the end, this research shows the importance of evidence-based medical practice. By applying prediction tools such as Cha2DS2-Vasc, medical personnel can be more proactive in planning and carrying out appropriate care for AMI patients. In the future, further research is needed to explore other factors that may contribute to the events of CIN, as well as to validate these findings to a broader population.

Recommendations

Based on the findings of this study, the following recommendations are made:

Use of Cha2DS2-Vasc scores as a prediction tool: Cha2DS2-Vasc scores can be used as a simple and reliable tool to predict CIN in AMI patients undergoing PCI.
Identification of high-risk patients: Cha2DS2-Vasc scores can be used to identify patients at high risk of experiencing CIN, allowing for more proactive planning and care.
Precautions for CIN prevention: Doctors can take precautions, such as the right hydration before and after the procedure or considering the use of alternative contrast agents that have low potential in triggering kidney damage.
Further research: Further research is needed to explore other factors that may contribute to the events of CIN, as well as to validate these findings to a broader population.

Limitations

This study has several limitations, including:

Small sample size: The study was conducted on a small sample size of 40 patients.
Limited generalizability: The findings of this study may not be generalizable to a broader population.
Lack of control group: There was no control group in this study, which may have affected the results.

Future Directions

Future research should aim to:

Explore other factors contributing to CIN: Further research is needed to explore other factors that may contribute to the events of CIN.
Validate findings to a broader population: The findings of this study should be validated to a broader population to ensure generalizability.
Develop more effective prediction tools: More effective prediction tools should be developed to identify patients at high risk of experiencing CIN.
Q&A: Understanding the Relationship Between Cha2DS2-Vasc Scores and Contrast-Induced Nephropathy

Q: What is contrast-induced nephropathy (CIN)?

A: Contrast-induced nephropathy (CIN) is a serious complication that can arise after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). It is characterized by a sudden decrease in kidney function, often leading to increased morbidity and mortality rates.

Q: What is the Cha2DS2-Vasc score?

A: The Cha2DS2-Vasc score is a clinical prediction tool used to assess the risk of stroke and other cardiovascular events in patients with atrial fibrillation. It takes into account several risk factors, including age, sex, heart failure, hypertension, diabetes, stroke, and vascular disease.

Q: How is the Cha2DS2-Vasc score related to CIN?

A: The Cha2DS2-Vasc score has been found to be positively related to the risk of CIN in patients with AMI undergoing PCI. This means that patients with higher Cha2DS2-Vasc scores are at a higher risk of developing CIN.

Q: What are the implications of this relationship?

A: The relationship between Cha2DS2-Vasc scores and CIN has significant implications for clinical practice. It suggests that patients with higher Cha2DS2-Vasc scores may require more aggressive preventive measures to reduce the risk of CIN.

Q: What are some potential preventive measures for CIN?

A: Some potential preventive measures for CIN include:

Hydration: Adequate hydration before and after the procedure can help reduce the risk of CIN.
Alternative contrast agents: Using alternative contrast agents that have lower potential for triggering kidney damage may also help reduce the risk of CIN.
Monitoring: Close monitoring of kidney function before and after the procedure can help identify patients at risk of CIN.

Q: What are the limitations of this study?

A: This study has several limitations, including a small sample size and limited generalizability to a broader population. Further research is needed to validate these findings and explore other factors that may contribute to the risk of CIN.

Q: What are the future directions for research on CIN?

A: Future research should aim to:

Explore other factors contributing to CIN: Further research is needed to explore other factors that may contribute to the risk of CIN.
Validate findings to a broader population: The findings of this study should be validated to a broader population to ensure generalizability.
Develop more effective prediction tools: More effective prediction tools should be developed to identify patients at high risk of experiencing CIN.

Q: What are the implications of this research for clinical practice?

A: This research has significant implications for clinical practice, particularly in the management of patients with AMI undergoing PCI. It highlights the importance of using Cha2DS2-Vasc scores as a prediction tool to identify patients at high risk of CIN and to develop more effective preventive measures.

Q: What are the next steps for this research?

A: The next steps for this research include:

Further validation: Further validation of the findings of this study to a broader population.
Development of more effective prediction tools: Development of more effective prediction tools to identify patients at high risk of CIN.
Implementation of preventive measures: Implementation of preventive measures to reduce the risk of CIN in patients with AMI undergoing PCI.