CHA2DS2-VASc Score as an Independent Predictor of Suboptimal Reperfusion and Short-Term Mortality after Primary PCI in Patients with Acute ST Segment Elevation Myocardial Infarction

Abstract

Background and objectives: We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. Materials and Methods: We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Patients were divided into two groups according to low and high CHA2DS2-VASc score. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and the likelihood of suboptimal TIMI flow. The secondary endpoint of the study was short-term in-hospital mortality of all cause. Results: The present study confirmed that CHA2DS2-VASc model enables us to determine the risk of no-reflow and all-cause in-hospital mortality independently. Odds ratios were 1.59 (1.30–2.25) and 1.60 (1.17–2.19), respectively. Moreover, BMI, high thrombus grade, and cardiogenic shock were predictors of failed reperfusion (odds were 1.07 (1.01–1.35), 1.59 (1.28–1.76), and 8.65 (3.76–24.46), respectively). We showed that using a cut off value of ≥ two in CHA2DS2-VASc model provides a sensitivity of 69.7% and specificity of 64.4% for discrimination of increased mortality hazards. Area under the curve: 0.72 with 95% CI (0.62–0.81). Conclusions: Calculation of CHA2DS2-VASc score applied as a simple risk stratification tool before primary PCI affords great predictive power. Furthermore, incremental values are obtained by using both CHA2DS2-VASc and no-reflow regarding mortality risk assessment.

Evaluation of the predictive value of CHA2DS2-VASc Score for no-reflow phenomenon in patients with ST-segment elevation myocardial infarction who underwent Primary Percutaneous Coronary Intervention

“…This study found that increased CHA2DS2-VASc score is an independent predictor of mortality rather than a surrogate measure only. This was in agreement with other studies [6][7][8].…”

“…This study had con irmed enhanced mortality and morbidity in the presence of no-re low phenomenon. Other studies [5,6,16] displayed independent predictive role of diabetes mellitus, which was similar to the results of this study. However, it was found a borderline statistical signi icance for this relationship.…”

“…This study found that high blood pressure, female gender, acute and chronic kidney injury, high levels of in lammatory biomarkers, involvement of LAD territory, and complex atherosclerotic plaques containing high thrombus burden were of great signi icance which coincided with Ashoori, et al [6].…”

“…Previous investigations [5,6,16] detected various determinants of suboptimal reperfusion following primary PCI. Heart failure (embedded in CHA2DS2-VASc score), cardiogenic shock, and high thrombus burden were also found in this study in line with former reports.…”

“…The thrombolysis in myocardial infarction (TIMI) stream was decided after primary PCI, comprised of four grades: TIMI-0 shows that there's no forward coronary stream in angiography post the location of stenosis or impediment, TIMI-1 depicts a destitute distal antegrade stream driving to de icient illing of the supply route, TIMI-2 illustrates a conceded moderate frontward stream that ills the distal region totally, TIMI-3 delineates typical coronary stream [6].…”