造影剂肾病(CIN)是冠状动脉造影患者的主要不良事件。Mehran风险模型是CIN风险预测的黄金标准。然而,与更现代的国家心血管数据注册-急性肾损伤(NCDR-AKI)风险模型相比,其性能仍然未知.我们的目的是在这项研究中比较两者。
在总共2067例接受冠状动脉造影术且有或没有经皮冠状动脉介入治疗的患者中,评估了Mehran和NCDR-AKI风险模型的预测以及CIN和透析需要的临床事件。比较了风险模型的区别(接受者操作特征分析),净重新分类改进(NRI)和校准(图形和统计分析)。NCDR风险模型显示预测CIN的风险区分度较高(NCDRc指数0.75,95%CI0.72-0.78;Mehranc指数0.69,95%CI0.66-0.72,p<0.01),和连续NRI(0.22;95%CI0.12-0.32;p<0.01)与Mehran模型相比。NCDR风险模型倾向于低估CIN的风险,而Mehran模型更均匀地校准。对于透析需求的预测,NCDR-AKI-D也更好地区分了风险(c指数0.85,95%CI0.79-0.91;与Mehranc指数0.75,95%CI0.66-0.84;pNCDRvsMehran<0.01),但连续NRI未显示获益,校准分析显示透析风险被低估.
在接受冠状动脉造影的德国患者中,与Mehran模型相比,用于预测对比剂肾病的现代NCDR风险模型显示出较高的辨别力,但校正准确性较低.结果“需要透析”是模棱两可的。
Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (
NCDR-AKI) risk models remains unknown. We aimed to compare both in this study.
Predictions of Mehran and
NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The
NCDR risk model showed superior risk discrimination for predicting CIN (
NCDR c-index 0.75, 95% CI 0.72-0.78; vs. Mehran c-index 0.69, 95% CI 0.66-0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12-0.32; p < 0.01) compared to the Mehran model. The
NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis,
NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79-0.91; vs. Mehran c-index 0.75, 95% CI 0.66-0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk.
In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the Mehran model while showing less accurate calibration. Results for the outcome \'need for dialysis\' were equivocal.