Diagnostic Performance of the CHAâ‚‚DSâ‚‚-VASc Score for Predicting Contrast-Induced Nephropathy in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: A Prospective Cohort Study

Abstract

Objectives: This study aimed to evaluate the diagnostic performance of the CHAâ‚‚DSâ‚‚-VASc score for predicting CIN in STEMI patients undergoing pPCI. Methodology: A total of 218 consecutive STEMI patients aged 18–80 years undergoing successful pPCI were enrolled. The CHA₂DS₂-VASc score was calculated pre-procedurally for each patient. CIN was defined as an absolute increase in serum creatinine ≥0.5 mg/dL or a relative increase ≥25% from baseline within 48–72 hours post-contrast exposure. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to assess discriminatory ability and independent association. Results: CIN developed in 81 patients (37.2%). The mean age was 56.91 ± 10.15 years, and 70.2% were male. At a CHA₂DS₂-VASc cutoff of ≥4, sensitivity was 41.98%, specificity 97.81%, PPV 91.89%, NPV 74.03%, and overall diagnostic accuracy 77.06%. ROC analysis demonstrated an area under the curve (AUC) of 0.70 (95% CI: 0.63–0.77; p < 0.001). In multivariable analysis, each one-point increase in CHA₂DS₂-VASc score independently increased the odds of CIN (adjusted OR 2.40; 95% CI 1.46–3.97; p = 0.001). Conclusion: The CHAâ‚‚DSâ‚‚-VASc score demonstrates high specificity and strong rule-in capability for predicting CIN in STEMI patients undergoing pPCI. While its limited sensitivity precludes use as a standalone screening tool, its simplicity and pre-procedural availability make it a practical adjunct for bedside risk stratification and targeted preventive interventions.