Correlation Between CHA₂DS₂-VASc Score And No-reflow After Primary Percutaneous Coronary Intervention In Patients With Acute ST-segment Elevation Myocardial Infarction

Background:Acute ST-segment elevation myocardial infarction is a common clinical emergency.If the criminal blood vessel is not opened urgently,it is mostly related to the occurrence of high mortality.Coronary no-reflow（CNR）is a common complication after Primary percutaneous coronary intervention（PPCI）.Although progress has been made in pharmacological and non-pharmacological treatments in recent years,according to domestic and foreign literature reports,the occurrence of CNR is far more common than expected and it is closely related to the poor prognosis.It is currently believed that remote microthromboembolism,ischemia-related injury,reperfusion injury,and individual susceptibility may play an important role in the occurrence of CNR.The CHA₂DS₂-VASc score is used as a guideline recommended method for stratification of stroke risk in patients with non-valvular atrial fibrillation（AF）,and is used to guide clinical antiplatelet or anticoagulation therapy.Atherosclerosis,endothelial injury,and thromboembolism are regarded as risk factors for ischemic stroke,while distal coronary artery thromboembolism and endothelial cell swelling are also important mechanisms for CNR.The overlap of risk factors and pathophysiological processes provides an important theoretical basis for the CHA₂DS₂-VASc score to predict CNR in STEMI patients after PPCI.Objective:The purpose of this study was to investigate the value of CHA₂DS₂-VASc score in predicting the occurrence of CNR after PPCI in patients with STEMI,in order to find a simple and effective risk scoring system to predict the occurrence of CNR so as to guide the implementation of corresponding preventive measures before surgery and improve the prognosis of STEMI patients.Methods:Patients with STEMI who underwent PPCI in the Department of Cardiology,Subei people’s Hospital of Jiang Su Province from January 2018 to June 2020 were selected,and patients with pain lasting more than 12 hours,experiencing remedial PCI after thrombolysis failure,incomplete clinical data,no stent implantation,acute infection or multiple organ failure were excluded.According to the TIMI blood flow grading after coronary angiography,the patients were divided into CNR group（TIMI blood flow≤2）and normal coronary flow（NCF）group（TIMI blood flow=3）.Collect all patients’baseline clinical data（age,gender,heart rate,blood pressure,diabetes history,history of congestive heart failure）,preoperative drug using（aspirin,statins,diuretics,insulin）,laboratory indicators（cell count in blood,glomerular filtration rate,blood lipids,D-dimer,creatinine）and PPCI related information（stent diameter,number of stents,complications）.Based on the review of previous medical history,all patients were scored using the CHA2DS2-VASc scoring system.Independent risk factors of CNR after PPCI were measured by univariate and multivariate regression analysis.The receiver operating characteristic（ROC）curve was used to analyze the CHA₂DS₂-VASc score to predict the cut-off point of CNR.Results:The CHA₂DS₂-VASc score were significantly higher in CNR group compared to control group（3.39±1.79 vs 1.97±1.51,P<0.001）.Multivariate logistic regression analysis showed that the CHA₂DS₂-VASc score was an independent predictor of CNR after PPCI（OR=1.481,95%CI:1.200-1.828,P<0.001）.In addition,in our study,preoperative TIMI blood flow is another independent predictor of postoperative CNR（OR=2.712,95%CI:1.238-5.939,P=0.013）.Receiver operating characteristics curve analysis revealed the cut-off value of CHA₂DS₂-VASc score≥3 as a predictor of CNR（AUC=0.729,95%CI:0.651-0.806）,with a sensitivity of 71.4%and a specificity of66.5%.Logistic multivariate regression analysis was used to analyze the predictive value of various factors in the CHA2DS2-VASc scoring system for postoperative CNR.It was found that three variables of CHF,hypertension,and women could independently predict the occurrence of CNR after PPCI.Conclusions:1.The CHA2DS2-VASc score of the CNR group was significantly higher than that of the NCF group.After adjusting for confounding factors,the CHA2DS2-VASc score and preoperative TIMI blood flow were independent predictors of CNR after PPCI in STEMI patients.2.CHA2DS2-VASc score≥3 is classified as the best predictive cut-off point for CNR,the area under the curve is 0.729,the sensitivity is 71.4%and the specificity is66.5%.3.In the CHA2DS2-VASc scoring system,CHF,hypertension,and women can independently predict postoperative CNR and among them,CHF has the strongest predictive ability.