The Predictive Value Of The CHA₂DS₂-VASc-HSF Score For Slow Flow During Rotational Atherectomy

Objective:Coronary artery calcification（CAC）poses major challenge to successful percutaneous coronary intervention（PCI）.Rotational atherectomy（RA）is the major effective method to treat severely calcified coronary lesions,as one of the most common complications,slow flow significantly increases the risk of adverse clinical outcomes.This article mainly discusses the predictive value of the CHA₂DS₂-VASc-HSF score for slow flow in patients undergoing RA,in order to identify high-risk patients before RA,and take corresponding preventive measures in advance to improve the clinical efficacy of RA.Methods:From October 2019 to June 2022,patients admitted to the department of cardiology of affiliated provincial hospital of Anhui medical university for elective PCI due to coronary heart disease were retrospectively screened,240 patients received RA treatment with severe CAC in the target vessel were finally selected as study subjects,severe CAC was confirmed by coronary angiography（CAG）or intravascular ultrasound（IVUS）.CAG was performed immediately after RA to determine the forward blood flow of the target vessel,according to the thrombolysis in myocardial infarction（TIMI）flow grade,patients were divided into the non-slow flow group（TIMI flow grade 3）and the slow flow group（TIMI flow grade 0-2）.The basic clinical data,laboratory examinations,angiographic and interventional data of the two groups were compared,and CHA₂DS₂-VASc-HSF scores of all subjects were calculated.SPSS 26.0 statistical software was used to analyze the statistical differences of all data between the two groups,the statistically significant variables in the univariate regression analysis were then included in the multivariate regression analysis to obtain independent influential factors of slow flow.To evaluate the predictive value of relavant indicators of slow flow,Medcalc19.1.6 software was used to draw the receiver operating characteristic（ROC）curves and obtain the value of area under the curve（AUC）.Results:Totally 240 eligible patients were enrolled,including 185 in the non-slow flow group and 55 in the slow flow group.The statistical analysis showed that:1.Compared with the non-slow flow group,the CHA₂DS₂-VASc-HSF score was higher in the slow flow group,the proportion of patients with congestive heart failure,family history of cardiovascular disease,and history of stroke/transient ischemic attack was also significantly higher,while systolic blood pressure and left ventricular ejection fraction were significantly lower（P＜0.05）.2.The proportion of RA for right coronary artery and the final burr size of 1.5mm was lower in the slow flow group,while the final burr size of 1.25mm and intra-aortic balloon pump were more used,the reference diameter was smaller,and lesion length was longer with more rotablation times,the differences were all statistically significant（P＜0.05）.3.The multivariate Logistic regression analysis showed that the CHA₂DS₂-VASc-HSF score and lesion length were independent risk factors of slow flow,while reference diameter and systolic blood pressure were preventive factors.4.The ROC curve analysis revealed that in the prediction of slow flow,the AUC of CHA₂DS₂-VASc-HSF score,lesion length,reference diameter and systolic blood pressure was 0.706（95%CI:0.644-0.763,P＜0.001）,0.743（95%CI:0.670-0.815,P<0.001）,0.654（95%CI:0.576-0.732,P<0.001）,and 0.726（95%CI:0.656-0.795,P<0.001）,seperately;the AUC of the combined indicator constituted by CHA₂DS₂-VASc-HSF score,lesion length,reference diameter and systolic blood pressure was0.882（95%CI:0.834-0.920,P<0.001）,with a sensitivity of 78.2%and a specificity of82.7%,the maximum Youden’index was 0.609.5.The Delong method analysis showed that AUC difference of the combined indicator with CHA₂DS₂-VASc-HSF score,lesion length,reference diameter and systolic blood pressure was 0.176（95%CI:0.108-0.244）,0.139（95%CI:0.079-0.199）,0.227（95%CI:0.153-0.302）,and 0.156（95%CI:0.091-0.220）,seperately,and the differences were all statistically significant（P<0.001）,implying that the combined indicator was a more effective predictor in predicting slow flow.Conclusions:High CHA₂DS₂-VASc-HSF score was an independent risk factor of slow flow in patients undergoing RA,and it was effective in predicting slow flow;the CHA₂DS₂-VASc-HSF score combined with lesion length,reference diameter and systolic blood pressure provided additional predictive value for slow flow than individual indicators.