Zwolle risk score predicts contrast-induced acute kidney injury in STEMI patients undergoing PCI

Herz. 2015 Feb;40(1):109-15. doi: 10.1007/s00059-013-3957-1. Epub 2014 Mar 9.


Objective: Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Mehran risk score was defined originally in elective PCI and may be predictive of CI-AKI. The aim of the present study was to investigate whether the Zwolle score predicts CI-AKI in patients with acute STEMI undergoing primary PCI.

Patients and methods: We analyzed the data of 314 consecutive patients (mean age 56.3 ± 11.4 years) with acute STEMI undergoing primary PCI. The study population was divided into two groups according to CI-AKI development. The Mehran score, Zwolle score, baseline characteristics, and in-hospital outcomes were recorded.

Results: Patients with CI-AKI had higher Mehran and Zwolle scores. In a receiver operating characteristic (ROC) curve analysis, high area under the curve (AUC) values were determined for Zwolle and Mehran scores (0.85 and 0.79, respectively) for CI-AKI development. A Zwolle score greater than 2 predicted CI-AKI with a sensitivity of 76.3 % and a specificity of 75.4 %. A Mehran score greater than 5 predicted CI-AKI with a sensitivity of 71.1 % and a specificity of 73.6 %.

Conclusion: Zwolle score predicts CI-AKI slightly better than the Mehran score in patients with STEMI undergoing primary PCI. This simple score can be used at the catheterization laboratory for risk stratification for the development of CI-AKI.

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / diagnosis*
  • Contrast Media / adverse effects
  • Female
  • Humans
  • Iodine / adverse effects*
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / surgery*
  • Percutaneous Coronary Intervention / methods*
  • Radiography, Interventional / adverse effects
  • Reproducibility of Results
  • Risk Assessment / methods*
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Treatment Outcome


  • Contrast Media
  • Iodine