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.

Ammar Ashoori,Mohammad Alidoosti,Yaser Jenab,Arash Jalali,Alireza Amirzadegan,Babak Geraiely,Ali-Mohammad Haji-Zeinali,Hassan Aghajani,Saeed Ghodsi,Mojtaba Salarifar,Ebrahim Nematipour,Yones Nozari,Hamidreza Pourhosseini,Zahra Hosseini,Negar Omidi

doi:10.3390/medicina55020035

Ammar Ashoori, Mohammad Alidoosti + Show 13 more

Open Access

https://doi.org/10.3390/medicina55020035

Copy DOI

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.

Highlights

In the era of revascularization, primary percutaneous intervention (PCI) is the mainstay of the treatment of acute ST segment elevation myocardial infarction (STEMI) owing to favorable efficacyMedicina 2019, 55, 35; doi:10.3390/medicina55020035 www.mdpi.com/journal/medicinaMedicina 2019, 55, 35 rather than that of thrombolysis
We reviewed angiography sine films in order to evaluate no-reflow/slow flow incidence using a combination of TIMI flow and Myocardial blush grades (MBG)
1331 eligible patients in the Tehran Heart Center registry of STEMI were evaluated for CHA2DS2-VASc score and evidence of no-reflow by reviewing final angiographic results of the primary PCI procedure

Summary

Introduction

In the era of revascularization, primary percutaneous intervention (PCI) is the mainstay of the treatment of acute ST segment elevation myocardial infarction (STEMI) owing to favorable efficacyMedicina 2019, 55, 35; doi:10.3390/medicina55020035 www.mdpi.com/journal/medicinaMedicina 2019, 55, 35 rather than that of thrombolysis. The no-reflow phenomenon occurs because of heterogeneous factors including distal embolization of debris pertaining to ulcerated atherosclerotic plaques, microvascular damage, vasospasm, insults of oxidative stress, and reperfusion injury. This entity involves about 5–15% of cases undergoing revascularization. CHA2DS2 and CHA2DS2-VASc score models are widely applied to predict the risk of subsequent thromboembolic events in patients with atrial fibrillation [6]. Such instruments have represented ample power in estimating major adverse cardiovascular outcomes in the setting of acute coronary syndrome. The secondary endpoint of the study was short-term in-hospital mortality of all cause

Objectives

Methods

Results