TIMI Risk Index sebagai Prediktor Kejadian Nefropati Diinduksi Kontras pada Pasien yang Menjalani Intervensi Koroner Perkutan Primer di RS Haji Adam Malik Medan

Abstract

Introduction: ST-segment elevation myocardial infarction (STEMI) is an acute cardiovascular event that requires immediate treatment through Primary Percutaneous Coronary Intervention (PPCI). PPCI increases the risk of Contrast-Induced Nephropathy (CIN), which is characterized by a serum creatinine increase of more than 25% or 0.5 mg/dL from baseline creatinine levels. To reduce the risk of CIN in patients undergoing PPCI, a simple scoring system is needed to predict CIN risk. This study aims to evaluate the TIMI Risk Index (TRI) as a predictor of contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention at Haji Adam Malik Hospital, Medan. Method: This study is an analytical observational study with a cross-sectional design on STEMI patients with an onset of less than 12 hours who underwent primary percutaneous coronary intervention at H. Adam Malik Hospital, Medan, and met the inclusion and exclusion criteria. Sampling was conducted from January 2023 to December 2024. Bivariate analysis was performed using the chi-square test if the data were normally distributed and the Fisher exact test if the data were not normally distributed. Statistical analysis was conducted using computer-based statistical software, with a p-value < 0.05 considered statistically significant. Results: The TRI demonstrated good predictive ability for CIN occurrence, with a p-value of 0.0001, an AUC of 0.834, and a 95% CI of 0.752–0.916. A TRI cut-off score of 23.47 showed a sensitivity of 77.3% and a specificity of 77%, with a positive predictive value (PPV) of 47.05% and a negative predictive value (NPV) of 91.8% for predicting CIN in patients undergoing PPCI. Conclusion: The TRI with a cut-off score of 23.47 can be used as a predictor of CIN occurrence in patients undergoing PPCI, with a sensitivity of 77.3% and a specificity of 77%, a PPV of 47.05%, and an NPV of 91.8%.