Study on a nomogram prediction model for contrast-induced nephropathy after emergency PCI in AMI patients

ObjectiveTo investigate the incidence and main risk factors of contrast-induced nephropathy(CIN) after emergency percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI), and establish a quantitative nomogram risk prediction model to guide clinical application.

MethodsA total of 1 417 patients with AMI undergoing PCI were selected as the study subjects, and the patients were divided into CIN group(n=180) and non-CIN group(n=1 237).Univariate and multivariate logistic regression analysis were used to screen the main risk factors, and a nomogram model was established.The receiver operating characteristic(ROC) curve was applied to analyze the predictive efficacy, and Hosmer-Lemeshow test was used to calculate the goodness of fit.According to the nomogram score, the patients were divided into low-risk, medium-risk and high-risk group, and the incidence of CIN was compared among the groups.

ResultsCompared with the non-CIN group, the patients in the CIN group with age >75 years old increased, the level of diastolic blood pressure, preoperative serum creatinine, total bilirubin, globulin, creatine kinase isoenzyme and C-reactive protein increased, and the left ventricular ejection fraction(LVEF) < 40%, glomerular filtration rate(eGFR) < mL·min^-1·1.73 m^-2, metformin application rate and contrast dosage >300 mL increased, but the operation time, number of target vessels, uric acid, urea nitrogen, albumin, low density lipoprotein and fasting blood glucose decreased, and the differences of which were statistically significant(P < 0.05 to P < 0.01).Multivariate regression analysis showed that LVEF < 40%, eGFR < mL·min^-1·1.73 m^-2 and contrast dosage >300 mL were the main risk factors for CIN(P < 0.01).The predictive efficacy of nomogram by ROC curve analysis was 0.867, which was significantly higher than that of the internal validation Mehran score(0.712)(P < 0.01).The calibration curve showed that the predicted results were in good agreement with the actual results.The incidence of CIN in high-risk patients was significantly higher than that in medium-risk patients, and the incidence of CIN in medium-risk patients was significantly higher than that in low-risk patients(P < 0.01).

ConclusionsAMI patients have a higher incidence of CIN after emergency PCI.LVEF < 40%, eGFR < mL·min^-1·1.73 m^-2 and contrast dosage >300 mL are the main risk factors.The quantitative nomogram risk model has a good predictive efficacy and is worthy of application.