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    Mehran Score for Post-PCI Contrast Nephropathy

    Predicts risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).
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    INSTRUCTIONS

    Use variables at the time of PCI.

    When to Use
    Pearls/Pitfalls

    Use in patients undergoing PCI. Do not use in patients with pre-existing end-stage renal disease on dialysis or patients with contrast exposure within 1 week of the index procedure.

    In the original study, “contrast-induced nephropathy” was defined as an increase ≥0.5 mg/dL (or ≥25%) in pre-PCI serum creatinine at 48 hours post-PCI.

    No
    0
    Yes
    +5
    No
    0
    Yes
    +5
    No
    0
    Yes
    +5
    No
    0
    Yes
    +4
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    mL
    ≥60
    0
    40 to <60
    +2
    20 to <40
    +4
    <20
    +6

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    Consider renal protective measures such as N-acetylcysteine and limiting contrast volume in patients at high risk of CIN.

    Formula

    Addition of the selected points:

    Variable

    Points

    Hypotension*

    No

    0

    Yes

    5

    Intra-aortic balloon pump

    No

    0

    Yes

    5

    Congestive heart failure**

    No

    0

    Yes

    5

    Age >75 years

    No

    0

    Yes

    4

    Anemia***

    No

    0

    Yes

    3

    Diabetes

    No

    0

    Yes

    3

    Contrast media volume

    -

    1 point per 100 mL contrast

    eGFR, mL/min/1.73 m2

    ≥60

    0

    40 to <60

    2

    20 to <40

    4

    <20

    6

    *Systolic blood pressure <80 mmHg for at least 1 hour requiring inotropic support with medications or intra-aortic balloon pump within 24 hours periprocedurally.

    **CHF class III/IV by New York Heart Association Classification and/or history of pulmonary edema.

    ***Baseline hematocrit value <39% for men and <36% for women.

    Note: the original study includes serum creatinine (as a dichotomous variable) as an alternative to eGFR, and adds 4 points for Cr >1.5 mg/dL. We have chosen to use eGFR in this calculator as it tends to be a more accurate measure of renal function than creatinine alone.

    Facts & Figures

    Interpretation:

    CIN Risk Score

    Risk of post-PCI CIN

    Any CIN

    CIN requiring dialysis

    ≤5

    7.5%

    0.04%

    6-10

    14.0%

    0.12%

    11-15

    26.1%

    1.09%

    ≥16

    57.3%

    12.6%


    Literature

    Validation

    Research PaperWi J, Ko YG, Shin DH, et al. Prediction of Contrast-Induced Nephropathy With Persistent Renal Dysfunction and Adverse Long-term Outcomes in Patients With Acute Myocardial Infarction Using the Mehran Risk Score. Clin Cardiol. 2013;36(1):46-53.Research PaperSgura FA, Bertelli L, Monopoli D, et al. Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv. 2010;3(5):491-8.Research PaperRaingruber B, Kirkland-walsh H, Chahon N, Kellermann M. Using the Mehran risk scoring tool to predict risk for contrast medium-induced nephropathy in patients undergoing percutaneous angiography. Crit Care Nurse. 2011;31(1):e17-22.Research PaperAbellás-sequeiros RA, Raposeiras-roubín S, Abu-assi E, et al. Mehran contrast nephropathy risk score: Is it still useful 10 years later?. J Cardiol. 2016;67(3):262-7.
    Dr. Roxana Mehran

    About the Creator

    Roxana Mehran, MD, FACC, FACP, FCCP, FESC, FAHA, FSCAI, is a professor in the department of medicine, cardiology, and population health science and policy at the Icahn School of Medicine at Mount Sinai. She is also the director of the Center for Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A. Wiener Cardiovascular Institute. Dr. Mehran’s primary research is focused on angioplasty and stent placement, cardiac catheterization, and acute coronary syndromes.

    To view Dr. Roxana Mehran's publications, visit PubMed