Abstract
Background In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). Objective The present study aimed to determine the impact of lesion complexity and the CHA2DS2-VASc score on SR in patients with STEMI. Methods A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(−) (n = 1402), according to their initial angiography and SR status. CHA2DS2-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. Results The CHA2DS2-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(−) (mean CHA2DS2-VASc, 1.36 ± 0.64 vs. 2.01 ± 0.80, p < 0.001; mean SYNTAX score, 15.51 ± 5.94 vs. 17.08 ± 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA2DS2-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(−) (0% vs. 6.7%, p < 0.001). Conclusion Our study demonstrated that lesion complexity and the CHA2DS2-VASc score are independently associated with spontaneous reperfusion.
Highlights
Acute coronary syndromes (ACS) are the leading causes of death worldwide [1]. e plaque rupture and erosion followed by thrombus formation within the vessel lumen are significant etiologies in the pathophysiology of ACS [2]. e absence of collateral perfusion in the setting of complete coronary occlusion results in acute ST-segment elevation myocardial infarction (STEMI)
When determining the severity of coronary artery disease (CAD), the SYNTAX score was calculated based on the total number, functional significance, and localizations of lesions detected on coronary angiography (CAG) and based on the presence of total occlusion, bifurcation, trifurcation, distal vessel bed, and thrombus formation
Our results indicated that lower CHA2DS2-VASc and SYNTAX scores are associated with spontaneous reperfusion (SR) development in STEMI patients
Summary
Acute coronary syndromes (ACS) are the leading causes of death worldwide [1]. e plaque rupture and erosion followed by thrombus formation within the vessel lumen are significant etiologies in the pathophysiology of ACS [2]. e absence of collateral perfusion in the setting of complete coronary occlusion results in acute ST-segment elevation myocardial infarction (STEMI). E present study was designed to examine the relationship between the CHA2DS2-VASc score, lesion complexity and SR in STEMI patients undergoing primary PCI. E CHA2DS2-VASc and the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) I scores were calculated for each patient using the following parameters: HFrEF (C), HT (H), aged over 75 years (A2), DM (D), stroke (S2), vascular disease (V), aged 65 years to 74 years (A), and female gender (sex category [Sc]). When determining the severity of CAD, the SYNTAX score was calculated based on the total number, functional significance, and localizations of lesions detected on CAG and based on the presence of total occlusion, bifurcation, trifurcation, distal vessel bed, and thrombus formation. Significance was assumed at a twosided p-value of
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