CHA2DS2-VAS-HSF Score as a Predictor for Contrast- Induced Nephropathy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Abstract

Introduction Contrast-induced nephropathy (CIN) is a significant complication for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This review examines the evolving application of the CHA2DS2-VASc score, a tool traditionally for assessing thromboembolic risk, as a predictor for CIN to guide preventive strategies in this high-risk population.

Methods This study is a comprehensive literature review synthesizing findings from three pivotal articles published between 2016 and 2024. The analysis tracks the score's application from its initial validation for assessing coronary artery disease (CAD) severity to its specific use as a CIN predictor in ACS patients post-PCI.

Results Initial research validated the CHA2DS2-VASc-HS score for assessing CAD severity and predicting in-hospital major adverse cardiovascular events (MACE). Subsequent studies established the CHA2DS2-VASc score as a novel CIN predictor, useful for risk stratification even in patients with normal renal function. The latest research identified additional significant risk factors such as anemia, admission hyperglycemia, and elevated blood urea nitrogen (BUN) , advocating for preventive measures like hydration and use of low-osmolar contrast media.

Discussion The findings show the CHA2DS2-VASc score is a simple and valuable tool for initial CIN risk stratification in daily clinical practice. However, the identification of other potent, independent risk factors highlights the limitation of relying on a single scoring system. This necessitates a more comprehensive and multifactorial risk assessment for accurate prediction and management.

Conclusion The CHA2DS2-VASc score should be integrated into routine clinical practice for predicting CIN in ACS patients undergoing PCI. For optimal prevention, a multifaceted approach is essential, combining the score with other key clinical and laboratory risk factors, such as anemia and hyperglycemia, to improve patient outcomes.