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Int J Med Sci 2018; 15(5):528-535. doi:10.7150/ijms.23064 This issue Cite

Research Paper

ADVANCIS Score Predicts Acute Kidney Injury After Percutaneous Coronary Intervention for Acute Coronary Syndrome

Pei-Chun Fan^1,2,5*, Tien-Hsing Chen^2,3*, Cheng-Chia Lee^1,2,5, Tsung-Yu Tsai^1,2,5, Yung-Chang Chen^2,4, Chih-Hsiang Chang^1,2,5✉

1. Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5 Fusing Street, Gueishan Dist., Taoyuan City 333, Taiwan (R.O.C.)
2. College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan (R.O.C.)
3. Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City 20401, Taiwan (R.O.C.)
4. Department of Nephrology, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City 20401, Taiwan (R.O.C.)
5. Graduate Institute of Clinical Medical Sciences, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan (R.O.C.)
* Pei-Chun Fan and Tien-Hsing Chen contributed equally to this manuscript

✉ Corresponding author: Chih-Hsiang Chang, MD., Kidney research center, Nephrology department, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, No. 5 Fusing Street, Gueishan Dist., Taoyuan City 333, Taiwan (R.O.C.) E-mail: franwisandsuncom; Phone No.: 886-3-3281200 ext 8181; Fax: 886-3-3282173 More

Abstract

Acute kidney injury (AKI), a common and crucial complication of acute coronary syndrome (ACS) after receiving percutaneous coronary intervention (PCI), is associated with increased mortality and adverse outcomes. This study aimed to develop and validate a risk prediction model for incident AKI after PCI for ACS. We included 82,186 patients admitted for ACS and receiving PCI between 1997 and 2011 from the Taiwan National Health Insurance Research Database and randomly divided them into a training cohort (n = 57,630) and validation cohort (n = 24,656) for risk model development and validation, respectively. Risk factor analysis revealed that age, diabetes mellitus, ventilator use, prior AKI, number of intervened vessels, chronic kidney disease (CKD), intra-aortic balloon pump (IABP) use, cardiogenic shock, female sex, prior stroke, peripheral arterial disease, hypertension, and heart failure were significant risk factors for incident AKI after PCI for ACS. The reduced model, ADVANCIS, comprised 8 clinical parameters (age, diabetes mellitus, ventilator use, prior AKI, number of intervened vessels, CKD, IABP use, cardiogenic shock), with a score scale ranging from 0 to 22, and performed comparably with the full model (area under the receiver operating characteristic curve, 87.4% vs 87.9%). An ADVANCIS score of ≥6 was associated with higher in-hospital mortality risk. In conclusion, the ADVANCIS score is a novel, simple, robust tool for predicting the risk of incident AKI after PCI for ACS, and it can aid in risk stratification to monitor patient care.

Keywords: Acute kidney injury, Acute coronary syndrome, Percutaneous coronary intervention, Mortality, Prediction model

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