CHA2DS2-VASc Score Predict No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention in Primary Percutaneous Coronary Intervention

Abstract

Introduction: No-reflow is one of the major complications of primary PCI in patients with acute ST elevation myocardial infarction. This phenomenon is associated with adverse outcomes in these patients. In the current study, we evaluated the effectiveness of CHA2DS2-VASc score in predicting no-reflow phenomenon. CHA2DS2-VASc score is a risk stratification method to estimate the risk of thromboembolism in patients with atrial fibrillation. Methods: In total, 396 patients with ST elevation myocardial infarction who had undergone primary PCI were evaluated in our study. Based on post interventional TIMI flow rate results, the patients were divided into two groups: control group (294 patients) and no-reflow group (102 patients). The CHA2DS2-VASc score was calculated for each participant. Multivariate regression analysis was performed to determine the predictive value of this score. Results: Our findings showed that CHA2DS2-VASc score can predict no-reflow independently (odds ratio: 3.06, 95%, confidence interval: 2.23-4.21, P <0 .001). Moreover, lower systolic blood pressure, higher diastolic blood pressure, grade 0 initial TIMI flow rate and smaller stent size were other independent predictors of the no-reflow in our study. We also defined a cut off value of ≥ 2 for the CHA2DS2-VASc score in predicting the no-reflow with a sensitivity of 88% and specificity of 67%, area under curve: 0.83 with 95% CI (0.79-0.88). Conclusion: The CHA2DS2-VASc score could be used as a simple applicable tool in the prediction of no-reflow before primary PCI in the acute ST elevation myocardial infarction patients.

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 revealed a dual prognostic utility of CHA2DS2-VASc for both suboptimal reperfusion and short-term mortality. This coincides with many studies who found a useful surrogate measure of in-hospital mortality independent of nore low [5,12,[14][15][16][17][18].…”

“…This study also revealed that lower systolic blood pressure was correlated with increased risk of no-re low independently. It might be related to reduction of coronary arterial perfusion pressure due to decreased blood pressure; this was similar to the results of Mirbolouk, et al [5]. Moreover, swelled myocardial cells concomitant with interstitial edema might lead to microvascular compression.…”

“…There was also an association between abnormal vascular function and stroke in this study which was indicated by Kim, et at. [24], although, opposing these results, Mirbolouk, et al [5] cohort found that there was no signi icant relationship between no-re low and female gender and stroke.…”

“…The components of this score are common hazard variables of atherosclerosis, microvascular injury as well as no-re low and stroke. Moreover, utilize of this score is exceptionally basic and makes it a speedy apparatus to predict no-re low phenomenon, comparative to common chance variables of the no-re low [5].…”

Serum cystatin C levels relate to no-reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction

“…Therefore, it is important to predict and prevent the noreflow phenomenon with PPCI. Several recent studies have shown that some clinical biomarkers and parameters can predict the risk of no-reflow phenomenon, such as the WBC count [21], D-dimer [22], neutrophil/lymphocyte ratio [23] and CHA2DS2-VASc score [24]. In the present study, the patients of no-reflow group were found to be more older, diabetics, longer pain-to-balloon time, lower blood pressure, higher platelet counts and higher levels of D-Dimer and Cys-C.…”