Objective Conduct a thorough examination of the potential risk factors that may lead to contrast-induced nephropathy following percutaneous coronary intervention(PCI)among elderly patients with coronary heart disease.Subsequently,develop a predictive risk model to assist in risk assessment and management.Methods A retrospective a-nalysis has been performed on the medical records of 216 elderly patients diagnosed with coronary heart disease who were admitted to our hospital between January 2018 and January 2023.According to the 80/20 rule,the patients were randomly divided into a training set(172 cases)and a validation set(44 cases).Referring to the contrast-induced ne-phropathy criteria established by the European Association of Urogenital Radiology,elderly patients who underwent percutaneous coronary intervention(PCI)for coronary heart disease were subsequently categorized into two distinct groups:those who developed contrast-induced nephropathy and those who did not.The study aimed to analyze the risk factors for contrast-induced nephropathy after PCI in elderly patients with coronary heart disease,and construct as well as validate a risk model.Results In 172 elderly patients with coronary heart disease who underwent routine PCI treat-ment,18 cases developed contrast agent nephropathy,with a rate of 10.47％(18/172).The preoperative glomerular fil-tration rate(GFR)in the contrast agent nephropathy group was lower than that in the non-contrast nephropathy group(P＜0.05).The postoperative second morning blood serum creatinine(Scr),urinary kidney injury molecule-1(KIM-1)and urinary neutrophil gelatinase-associated lipocalin(NGAL)on the postoperative second morning were higher in the contrast nephropathy group than in the non-contrast nephropathy group(P＜0.05).Preoperative GFR(OR=0.245,95％CI:0.141～0.426),postoperative second morning Scr(OR=3.438,95％CI:1.980～5.971),postoperative second morning urine KIM-1(OR=3.714,95％CI:2.138～6.449),and postoperative second morning urine NGAL(OR=4.973,95％CI:2.864～8.635)were the influencing factors for the development of contrast nephropathy in elderly pa-tients with coronary heart disease undergoing PCI(P＜0.05).The nomogram predicts that the sensitivity of elderly cor-onary heart disease patients with PCI after surgery for contrast-induced nephropathy is 0.809(95％CI:0.714～0.891),with a specificity of 0.758(95％CI:0.671～0.834)and a area under the curve of 0.829(95％CI:0.746～0.925).The model also predicts that the sensitivity of the validation set of elderly coronary heart disease patients with PCI after surgery for contrast-induced nephropathy is 0.799(95％CI:0.719～0.892),with a specificity of 0.685(95％CI:0.602～0.794)and an area under the curve of 0.813(95％CI:0.708～0.916).Conclusion Preoperative GFR,postoperative morning Scr,postoperative morning urine KIM-1,and postoperative morning urine NGAL are associated with contrast agent nephropathy in elderly patients with coronary heart disease after PCI.Constructing a risk model can help evaluate the risk of contrast agent kidney injury in the early stages of PCI.
Old ageCoronary heart diseasePercutaneous coronary interventionContrast agent nephropathyInflu-encing factorsprediction model
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