Relation of High CHA₂DS₂-VASc Score With Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Background Contrast-induced nephropathy (CIN) is a prevalent and significant complication after percutaneous coronary intervention (PCI), leading to heightened morbidity, mortality, and healthcare expenditures. Recognizing high-risk patients prior to the treatment is essential, particularly in resource-constrained environments such as Bangladesh. Numerous global research studies have indicated that the CHA₂DS₂-VASc, which comprises easily accessible clinical factors, may function as an intuitive prediction tool for CIN. Nevertheless, information concerning this association is scarce within the Bangladeshi context. Therefore, this study aimed to determine the relationship between high CHA₂DS₂-VASc scores and the development of CIN following PCI, and to evaluate the predictive value of this score. Methods This prospective observational study took place at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from July 2023 to July 2024. Patients who underwent PCI in the Department of Cardiology comprised the study population. A total of 104 patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) were recruited according to the selection criteria by convenience sampling. Participants were categorized into two groups based on their baseline CHA₂DS₂-VASc scores: Group A (score ≥2) and Group B (score <2), each including 52 patients. The occurrence of CIN, defined as an absolute rise in serum creatinine greater than 0.5 mg/dL or a relative increase of at least 25% from baseline within 48 to 72 hours after the procedure, was the primary outcome evaluated. The DMC's institutional review board granted approval for the study to proceed, subject to ethical considerations. Results CIN developed in 13.5% of the patients in this study. The incidence of CIN was significantly higher among patients with a CHA₂DS₂-VASc score ≥2 compared to those with a CHA₂DS₂-VASc score <2 (21.2% vs. 5.8%, p-value: 0.022). CIN showed significant associations with prior use of angiotensin receptor blockers (ARBs) and a CHA₂DS₂-VASc score ≥2. However, no statistically significant association was observed between CIN and the volume of contrast administered during the procedure. In multivariate logistic regression analysis, only a CHA₂DS₂-VASc score ≥2 remained an independent predictor of CIN (adjusted odds ratio (AOR) = 5.75; 95% confidence interval (CI): 1.663-19.92; p-value: 0.006), indicating that patients with higher CHA₂DS₂-VASc scores had more than fivefold increased odds of developing CIN. CHA₂DS₂-VASc score ≥2 had moderate sensitivity (78.57%) and low specificity (54.44%) for predicting CIN. It had a low positive predictive value but a high negative predictive value, indicating it was good for ruling out CIN and should be used as a screening tool rather than a confirmatory tool. Conclusion The development of CIN after PCI was significantly associated with a higher CHA₂DS₂-VASc score. Patients with a score ≥2 had significantly increased odds of developing CIN, and this remained an independent predictor. Moreover, the CHA₂DS₂-VASc score ≥2 is a simple and practical tool for early identification of patients at higher risk of CIN prior to PCI; it is particularly useful for ruling out CIN and is better suited as a screening rather than a confirmatory tool.