Prognostic impact of the Mehran 2 risk score on 1-year mortality after acute coronary syndrome

BACKGROUND: The Mehran 2 score was developed to predict contrast-associated acute kidney injury after percutaneous coronary intervention (PCI). Its prognostic value beyond renal complications remains uncertain. We evaluated the association of preprocedural (model 1) and postprocedural (model 2) Mehran 2 scores with renal outcomes and 1-year mortality in patients with acute coronary syndrome (ACS). METHODS: This single-center retrospective study included 1025 patients with ACS undergoing PCI. Both scores were calculated and categorized into four risk groups. The primary outcome was 1-year all-cause mortality, while secondary outcomes included contrast-induced nephropathy (CIN) and dialysis requirement. Prognostic performance was assessed using multivariable logistic regression, receiver operating characteristic analysis, and Kaplan-Meier survival analysis. RESULTS: CIN occurred in 105 patients (10.2%), dialysis was required in 21 (2.0%), and 102 (10.0%) died within 1 year. All outcomes increased progressively across Mehran 2 risk categories (P < 0.001). Both scores were independently associated with 1-year mortality [model 1: adjusted odds ratio (OR): 1.59, 95% confidence interval (CI): 1.37-1.84; model 2: adjusted OR: 1.60, 95% CI: 1.41-1.83; both P < 0.001]. The area under the curves (AUCs) for mortality were 0.794 and 0.806, respectively, with a modest improvement for model 2 (ΔAUC: 0.012; P = 0.049). Higher scores were associated with significantly lower 365-day survival (log-rank P < 0.001). CONCLUSION: Both Mehran 2 models were associated with renal complications and 1-year mortality in patients with ACS undergoing PCI. The preprocedural model may facilitate early cardiorenal risk stratification, whereas the postprocedural model provides only modest incremental discrimination. Further validation against established mortality risk scores is needed.