Combining clinical predictors to better predict for the no-reflow phenomenon

Abstract

OBJECTIVE: We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive Heart Failure, H: Hypertension, A2: Age ≥ 75 years, D: Diabetes mellitus, S: Stroke history, V: Vascular disease, A: Age ≥ 65 years, Sc: Sex category) and pre-percutaneous coronary intervention (PCI) thrombus load score was more sensitive at detecting the no-reflow phenomenon compared to the CHA2DS2-VASc score alone or to the thrombus load score alone in patients with acute ST-elevation myocardial infarction (STEMI) who had underwent primary PCI (PPCI). PATIENTS AND METHODS: 497 patients with acute STEMIs were divided into two groups: no-reflow group (n: 194) and control group (n: 303). The Thrombolysis In Myocardial Infarction (TIMI) flow grading and Myocardial Blush Grade (MBG) were used together to define angiographic no-reflow as TIMI flow < 3 (with any MBG grade) or TIMI flow 3 with MBG 0 or 1. Successful reperfusion was defined as TIMI flow 3 with MBG 2 or 3. RESULTS: CHA2DS2-VASc score was significantly higher in the no-reflow group than in the control group (2 [1-4] vs. 1 [0-3], p < 0.001]. Compared with the control group, the no-reflow group had a higher pre-PCI thrombus score (5 [4-5] vs. 4 [3-5], p = 0.001]. Compared with the CHA2DS2- VASc score alone, the combined use of the prePCI thrombus score and the CHA2DS2-VASc score was associated with significant improvements in the ability to predict no-reflow (AUC) (0.65 vs. 0.60, p < 0.05). The addition of the prePCI thrombus score to the CHA2DS2-VASc score was related to a significant net reclassification improvement of 6.7% (p = 0.047) and an integrated discrimination improvement of 0.036 (p < 0.05). CONCLUSIONS: We have found that the combination of a CHA2DS2-VASc score and a prePCI thrombus load score was more sensitive in detecting the no-reflow phenomenon than only a CHA2DS2-VASc score in patients who underwent PPCIs for STEMIs.