Predictive Accuracy of CHA₂ DS₂-VASc Score in Determining Infarct-Related Artery Patency in Patients with ST-Elevation Myocardial Infarction

Abstract

Introduction: Infarct related artery patency before percutaneous coronary intervention is associated with better clinical outcomes in ST elevation myocardial infarction patients. Infarction area is smaller and left ventricular functions are better preserved in patients with spontaneous reperfusion before primary percutaneous coronary intervention, which is associated with less cardiogenic shock and significantly lower mortality. CHA₂ DS₂-VASc score is a tool used in predicting the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation, although in recent years the focus has been on predictive value of CHA₂ DS₂-VASc score in a wide spectrum of cardiovascular diseases regardless of the presence of atrial fibrillation. The objective of this study was to evaluate the predictive accuracy of CHA₂ DS₂-VASc score in determining infarct related artery patency in ST elevation myocardial infarction patients.

Patients and Methods: A total of 723 patients who presented to our hospital with chest pain and underwent primary percutaneous coronary intervention with the diagnosis of ST elevation myocardial infarction were retrospectively analyzed. CHA₂ DS₂-VASc score was calculated separately for all patients. Study population was divided into two groups as the occluded infarct related artery group (TIMI 0, 1, 2) and patent infarct related artery group (TIMI 3). A multivariate logistic regression analysis was performed in order to determine predictive value of CHA₂ DS₂-VASc score.

Results: There were TIMI 0, 1 or 2 flow (occluded infarct related artery group) in 568 (78.6%) patients and TIMI 3 flow (patent infarct related artery group) in 155 (21.4%) patients. Patients in the occluded infarct related artery group had a significantly higher CHA₂ DS₂-VASc score compared to the patent infarct related artery group (2 ± 1 vs. 1 ± 1, p< 0.001). The result of Receiver Operating Characteristic (ROC) curve analysis carried out to predict infarct related artery patency was 0.74. We found that a CHA₂ DS₂-VASc score < 2 predicted infarct related artery patency with a sensitivity of 70.9% and a specificity of 44.5% (AUC: 0.735, 95% CI: 0.691-0.779, p< 0.001).

Conclusion: The CHA₂ DS₂-VASc score can be used as a simple and reliable tool to predict infarct related artery patency in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

This study was approved by Kartal Kosuyolu High Specialization Training and Research Hospital Ethics Committee (2021/3/476, Date: 09.02.2021).

Informed consent was obtained.

Externally peer-reviewed.

Concept/Design - ZŞ, RZ; Analysis/Interpretation - ZŞ, RZ; Data Collection - ZŞ, RZ; Writing - ZŞ, EA; Critical Revision - EÇ, EA; Statistical Analysis - EÇ, RZ; Overall Responsibility - ZŞ; Final Approval - All of authors.

The authors have no conflicts of interest to declare.

The authors declared that this study has received no financial support.