The Predictive Value Of CHA2DS2-VASc Score For No-reflow In Primary Percutaneous Coronary Intervention

Objective: No-reflow is one of the major complications of acute ST segment elevation myocardial infarction patients with primary percutaneous coronary interention(PCI).No-reflow was significantly associated with outcomes in these patients,which can lead to poor myocardial healing after infarction and poor left ventricular remodeling,increasing the risk of major adverse cardiac events,including congestive heart failure and death.CHA2DS2-VASc score is a hierarchical method for assessing the risk of thromboembolism in patients with atrial fibrillation.The components of this score are common risk factors for atherosclerosis,vasospasm,and microvascular dysfunction.Vasospasm and microvascular dysfunction are important factors leading to no-reflow.In this study,we assessed the validity of the CHA2DS2-VASc score in predicting no-reflow in patients with non-atrial fibrillation.Methods: patients with ST-segment elevation myocardial infarction who received primary PCI in the chest pain center of Hebei General Hospital from 2017-09 to 2018-08 were selected consecutively,and patients with atrial fibrillation,long-term oral anticoagulant,percutaneous transluminal coronary angioplasty,preoperative intravenous thrombolysis,perioperative replacement of heparin with bivarudine,patients with severe coagulation dysfunction and incomplete clinical and coronary angiography data were excluded.A total of 170 patients were enrolled for evaluation.According to the TIMI blood flow grading after coronary angiography,the patients were divided into two groups: the control group(139 patients)and the no-reflow group(31 patients).Collect baseline clinical data of two groups of patients(age,gender,heart rate,systolic blood pressure,diastolic blood pressure,total ischemia time,left ventricular ejection fraction,Killip classification,smoking history,diabeteshistory,history of hypertension,heart failure,history of vascular diseases,stroke/TIA history),assay data(creatinine,total cholesterol,low-density lipoprotein cholesterol,glomerular filtration rate)and the data of coronary angiography and PCI(thrombosis load grade,length of lesion,preoperative TIMI flow,thrombus aspiration,tirofiban in the coronary artery,stent diameter,number of stents,extension pressure of stent release and reperfusion method,etc).The preoperative CHA2DS2-VASc score of each patient was calculated.All data of the control group and the group of no-reflow were analyzed,and variables with significant P values were included in the multivariate regression analysis to determine the independent predictors of no-reflow and the predictive value of CHA2DS2-VASc score.Results: our results showed that the CHA2DS2-VASc score could independently predict no-reflow(OR : 3.06,95%CI: 1.63-5.75,P < 0.001).In addition,in our study,higher thrombotic load grade(OR : 6.08,95%CI: 2.67-13.9,P< 0.001),higher extension pressure of stent release(OR :1.92,95%CI:1.27-6.42,P=0.03)and pre-stent balloon dilation(OR : 2.18,95%CI: 1.26-5.26,P =0.034)were other independent predictors of no-reflow.Arterial systolic blood pressure(OR: 0.78,95%CI: 0.72-1.00,P =0.04)is a protective factor of coronary blood flow.We also defined the critical value of CHA2DS2-VASc score≥2,predicting no-flow,with a sensitivity of 64.5% and a specificity of 69.1%.The area under the ROC curve was 0.714 with 95%CI(0.606-0.821).Conclusions:1.CHA2DS2-VASc score is an independent predictor of no-reflow and can be used as a simple tool for predicting no-reflow before primary PCI in patients with acute ST-segment elevation myocardial infarction.2.Higher thrombotic load grade,higher extension pressure of stent release and pre-stent balloon dilation were independent predictors of no-reflow.3.Arterial systolic blood pressure is a protective factor of coronary blood flow.