Mehran Score for Post-PCI Contrast Nephropathy

Predicts risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Mehran Scoreshould be used in patients undergoing PCI.

NB! 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.

Hypotension (SBP <80 for ≥1 hr requiring inotrope or balloon pump within 24 hrs of cath)
Yes
No

Intra-aortic balloon pump:
Yes
No

Congestive heart failure (CHF class III/IV by New York Heart Association Classification and/or history of pulmonary edema):
Yes
No

Age >75 years:
Yes
No

Anemia (Baseline hematocrit value <39% for men and <36% for women):
Yes
No

Diabetes:
Yes
No

Contrast Media Volume in ml:

eGFR, mL/min/1.73 m²:
≥ 60
40 to < 60
20 to < 40
<20



Patient’s Score CIN Risk Score Risk of any post-PCI CIN Risk of post-PCI CIN requiring dialysis
0 0 0 0

Hypotension (SBP <80 for ≥1 hr requiring inotrope or balloon pump within 24 hrs of cath)+5
Intra-aortic balloon pump+5
Congestive heart failure (CHF class III/IV by New York Heart Association Classification and/or history of pulmonary edema)+5
Age >75 years+4
Anemia (Baseline hematocrit value <39% for men and <36% for women)  +3
Diabetes+3
Contrast Media Volume1 pt./100 mL contrast
eGFR, mL/min/1.73 m² 
≥600
40 to <60+2
20 to <40+4
<20+6

Interpretation:

CIN Risk ScoreRisk of any post-PCI CINRisk of post-PCI CIN requiring dialysis
≤57.5%0.04%
6-1014.0%0.12%
11-1526.1%1.09%
≥1657.3%12.6%

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.

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

References:

  1. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393-9. https://doi.org/10.1016/j.jacc.2004.06.068
  2. Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Spartà I, Politi L, Aprile A, Amato A, Rossi R, Biondi-Zoccai G, Sangiorgi GM, Modena MG. Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv. 2010 Oct;3(5):491-8. doi: 10.1161/CIRCINTERVENTIONS.110.955310. Epub 2010 Oct 5. PMID: 20923986.
  3. Bonnie Raingruber, Holly Kirkland-Walsh, Nikky Chahon, Michael Kellermann; Using the Mehran Risk Scoring Tool to Predict Risk for Contrast Medium–Induced Nephropathy in Patients Undergoing Percutaneous Angiography. Crit Care Nurse 1 February 2011; 31 (1): e17–e22. doi: https://doi.org/10.4037/ccn2011746
  4. Wi J, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Ha JW, Hong MK, Jang Y. 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 Jan;36(1):46-53. doi: 10.1002/clc.22060. Epub 2012 Oct 1. PMID: 23027701; PMCID: PMC6649613.
  5. Abellás-Sequeiros RA, Raposeiras-Roubín S, Abu-Assi E, González-Salvado V, Iglesias-Álvarez D, Redondo-Diéguez A, González-Ferreiro R, Ocaranza-Sánchez R, Peña-Gil C, García-Acuña JM, González-Juanatey JR. Mehran contrast nephropathy risk score: Is it still useful 10 years later? J Cardiol. 2016 Mar;67(3):262-7. doi: 10.1016/j.jjcc.2015.05.007. Epub 2015 Jul 10. PMID: 26169247.

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