الفهرس 
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Abstract
This was a prospective observational cohort study conducted on 200 patients with Acute coronary syndrome (ACS), and undergoing percutaneous coronary intervention (PCI); to evaluate the predictive value of PRECISE DAPT score for the development of contrast induced nephropathy (CIN) in acute coronary syndrome patients undergoing PCI, and compare its predictive power to Mehran score.
A total of 200 patients who have been diagnosed with Acute coronary syndrome, and undergoing PCI, patients were recruited from Ain Shams University Hospitals and enrolled in the study.
The primary end-point was the development of CIN after PCI. CIN defined as an increase of > 25%, and/or > 0.5 mg/dl in serum creatinine at 48-72 hours after PCI when compared to baseline value.
The predictive power of PRECISE-DAPT score was be tested, and the best cut-off value was determined. We compared the predictive power of PRECISE-DAPT score to Mehran risk score for the development of CIN.
Regarding pre-procedural data; we found that; the median age of all patients was (55) years. Regarding gender of the patients, the majority (74.5%) of patients were males; while (25.5%) were females. Regarding comorbidities; (6.5%) of patients had family history, (35.5%) had DM, (42%) had HTN, (18.5%) had Dyslipidemia, (10%) had history of anemia, (2.5%) had history of spontaneous bleeding, (10.5%) had old MI.
Regarding PCI interventional data; the average Contrast volume was (180) ml, and the average Duration of procedure was (50) min. Regarding Culprit artery; (65.5%) of patients had LAD, (13%) had LCX, and (21.5%) had RCA as culprit artery.
Regarding Complications during procedure; (3%) of patients had No flow, (4.5%) had Major bleeding, (27.5%) had Minor bleeding, (25%) had Acute Heart Failure, (0.5%) had CV accidents and (1%) had In-hospital mortality.
Regarding Outcome & Predictive data; the average Mehran score was (5), the average Precise DAPT score was (18), (10.5%) had Post-procedural CIN.
Patients with CIN had significantly higher incidence of arrhythmias (57.1% vs 38% p 0.031) ; no reflow (14.3% vs 1.7% p <0.016); major bleeding (19% vs 2.8% p =0.008); acute heart failure (42.9% vs 22.9 p 0.046) and death (9.5% vs 0.0 % p 0.011 ) compared to patients with no CIN.
Regarding Receiver-operating characteristic (ROC) curve for prediction of CIN; we found that;
• CV/eGFR ratio has fair predictive value (AUC = 0.72, 95% CI = 0.65 to 0.78, P = 0.0004). Best cut-off is CV/eGFR ratio >3.37 (sensitivity = 57.1%, 95% CI = 34.0% - 78.2%, specificity = 79.9%, 95% CI = 73.3% - 85.5%; J-index = 0.37).
• Mehran score has good predictive value (AUC = 0.79, 95% CI = 0.72 to 0.84, P < 0.0001). Best cut-off is Mehran score >6 (sensitivity = 81.0%, 95% CI = 58.1% - 94.6%, specificity = 67.6%, 95% CI = 60.2% - 74.4%; J-index = 0.49).
• PRECISE-DAPT score has excellent predictive value (AUC = 0.91, 95% CI = 0.86 to 0.94, P < 0.0001). Best cut-off is PRECISE-DAPT score >27 (sensitivity = 85.7%, 95% CI = 63.7% - 97.0%, specificity = 87.7%, 95% CI = 82.0% - 92.1%; J-index = 0.73).
• PRECISE-DAPT is significantly better than either Mehran score (ΔAUC = 0.12, 95% CI = 0.02 to 0.22, P = 0.018) or CV/eGFR (ΔAUC = 0.19, 95% CI = 0.06 to 0.32, P = 0.018). There is no statistically significant difference between Mehran and CV/eGFR. (ΔAUC = 0.07, 95% CI = -0.06 to 0.21, P = 0.304).
Conclusion: PRECISE-DAPT score showed a significant and excellent predictive value in predicting the development of contrast induced nephropathy (CIN) in acute coronary syndrome patients undergoing PCI, and its predictive power exceeded Mehran score and CV/eGFR ratio as well.
Logistic regression analysis showed that; Creatinine pre-PCI, wall motion score index, LAD infarction, and PRECISE DAPT score; all had an independent effect on increasing the probability of CIN occurrence; with significant statistical difference (p < 0.05 for all).
In our study, validation of Mehran score for prediction of CIN was achieved. It showed good predictive value (AUC = 0.79, 95% CI = 0.72 to 0.84, P < 0.0001). Best cut-off is Mehran score >6 (sensitivity = 81.0%, 95% CI = 58.1% - 94.6%, specificity = 67.6%, 95% CI = 60.2% - 74.4%; J-index = 0.49).