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.
Highlights
No-reflow is one of the major complications of primary percutaneous coronary intervention (PCI) in patients with acute ST elevation myocardial infarction
In comparison to control group, all components of CHA2DS2-VASc score, including history of heart failure, hypertension, age between 65 and 74, diabetes mellitus, history of stroke/transient ischemic attack, vascular disease, age ≥75, and female gender were significantly higher in the no-reflow group
History of previous myocardial infarction (MI) and peripheral arterial disease were more common in the no-reflow group, but history of previous by-pass surgery did not differ between the two groups (2.3% versus 1.7%, P = 0.19)
Summary
No-reflow is one of the major complications of primary percutaneous coronary intervention (PCI) in patients with acute ST elevation myocardial infarction. 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. No-reflow is defined as inadequate myocardial perfusion despite mechanical reopening of the culprit lesion with PCI This phenomenon is related to higher incidence of complications, and short- and longterm morbidity and mortality in acute STEMI patients.[3,4] This phenomenon occurs in 0.6% to 5% of elective PCIs, but a higher incidence has been reported in patients who underwent primary PCI.[5,6] A multifactorial and complex pathophysiology has been suggested for mechanism of this event.[4,7,8] there is no widely accepted risk stratification method for the prediction of this complication.
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