New CHA2DS2-VASc-HSF score predicts the no-reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Abstract

Background: The no-reflow phenomenon (NRP) is a serious complication of primary percutaneous coronary intervention (PPCI) and is an independent predictor of poor prognosis. We aimed to find a simple but effective risk stratification method for the prediction of NRP. Methods: This retrospective single-center study included 454 consecutive patients diagnosed with acute STsegment elevation myocardial infarction (STEMI) and treated by PPCI, who were admitted to our emergency department between January 2017 and March 2019. The patients were divided according to the post-PPCI thrombolysis in the myocardial infarction flow rate: the NRP group and the control group. The CHADS 2 , CHA 2 DS 2-VASc, and CHA 2 DS 2-VASc-HSF scores were calculated for all the patients in this study, and multivariable regression and receiver operating characteristic curve analyses were conducted to determine the independent predictors of NRP and the predictive value of the three scores. Results: A total of 454 patients were analyzed in this study: 80 in the no-reflow group and 374 in the control group. The incidence of NRP was 17.6%. Creatine kinase-myocardial band, Killip class, stent length, and multivessel disease also independently predicted NRP. The CHA 2 DS 2-VASc-HSF score had a higher predictive value than the other two scores, and a CHA 2 DS 2-VASc-HSF score of ≥4 predicted NRP with a sensitivity of 72.5% and specificity of 66.5% (area under the curve: 0.755, 95% confidence interval [0.702-0.808]). Conclusion: Although the CHADS 2 , CHA 2 DS 2-VASc, and CHA 2 DS 2-VASc-HSF scores can all be used as simple tools to predict NRP, our findings show that the CHA 2 DS 2-VASc-HSF score had the highest predictive value. Thus, the CHA 2 DS 2-VASc-HSF score may be an optimal tool for predicting high-risk patients.

Machine learning to predict no reflow and in-hospital mortality in patients with ST-segment elevation myocardial infarction that underwent primary percutaneous coronary intervention

“…Various studies have developed predictive models for the occurrence of NR in STEMI patients who underwent pPCI. These models were based on variables such as the atherogenic index of plasma (log TG/HDL-C) [ 15 ], the neutrophil-to-lymphocyte ratio [ 16 ], the lymphocyte-to-monocyte ratio [ 17 ], the fibrinogen-to-albumin ratio [ 18 ], R wave peak time [ 19 ], a combination of plasma D-Dimer and endothelin-1 levels [ 20 ], plasma D-Dimer and pre-infarction angina [ 21 ], a combination of pre-infarction angina and mean platelet volume to lymphocyte count ratio [ 22 ], the red cell distribution width–platelet ratio (RPR) [ 23 ], CHA2DS2-VASc [ 24 ] or CHA2DS2-VASc-HSF score [ 25 ], and some new risk scoring system [ 26 ]. Based on the AUC values, moderate accuracy was observed in this study, which is similar to previous reports.…”

The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention

“…42–44 In another study, the new CHA 2 DS 2 -VASc-HSF score, which includes hyperlipidemia, smoking, and family history for coronary artery disease in addition to the classical score, was found to be an independent predictor of NR in patients with STEMI treated with pPCI. 17 The NR risk was increased in those with a score ≥2 in the study by İpek et al 45…”

“…6–15 Cheng et al 16 demonstrated higher levels of d -dimer and cystatin C in patients with NR in their study consisting of 218 acute anterior myocardial infarction (MI). In another study by Zhang et al, 17 HA 2 DS 2 -VASc-HSF score, defined as the new onset of congestive heart failure, hypertension, age (≥65 = 1 point, ≥75 = 2 points), diabetes, stroke/transient ischemic attack (2 points), and vascular disease (peripheral arterial disease, previous MI, and aortic atheroma), hyperlipidemia (H), smoking (S), and a family history of coronary heart disease (F), which includes hyperlipidemia, smoking, and family history for coronary artery disease in addition to classical score, was found to be an independent predictor of NR in patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI (pPCI).…”

“…Similarly, previous studies have shown that the traditional risk factors for coronary artery diseases are also risk factors for NR. 17…”

CHA2DS2-VASc-HSF Score may Better Predict the Development of Total Coronary Artery Occlusion in Acute Coronary Syndrome

“…Andrianto et al 11 reported the better performance of CHA2DS2-VASc-HSF score in predicting of CAD severity compared with CHADS2 and CHADS2-VASc scores. In another study, 12 the CHA2DS2-VASc-HSF score was more successful in showing no-reflow phenomenon after PCI in patients with acute coronary syndrome compared with the CHADS2 and CHA2DS2-VASc scores. In addition, Kalyoncuoglu et al 13 found that the CHA2DS2-VASc-HSF score better predicted the 1-year cardiovascular outcomes and major adverse cardiac and cerebrovascular events compared with the CHADS2 and CHADS2-VASc scores in patients with NSTEMI.…”