Usefulness of the CHA2DS2-VASc Score to Predict “St Segment Resolution Failure” In Patients Treated With Primary Percutaneous Coronary Intervention for St-Segment Elevation Myocardial Infarction

Abstract

Background: Rapid supply of coronary blood flow in the occluded coronary artery is the principle aim of early ST-elevation myocardial infarction (STEMI) therapy. Although coronary blood flow has been supplied, insufficient myocardial reperfusion mainly at the level of micro vascular circulation has been assessed a large number of patients. Electrocardiographically by measuring ST-segment resolution (STR) after procedure is an easy and good indicator for the evaluation of reperfusion failure. The CHA₂DS₂-VASc risk score is used to predict the risk of thromboembolism in non-valvular AF patients. Its usefulness in predicting AF in the development of STR failure in patients presenting with STEMI is unknown. We evaluated the predictive value of the CHA2DS2-VASc score in patients with STR failure following STEMI.

Methods: Models including clinical and laboratory parameters were constructed to test the predictive value of CHA2DS2-VASc and CHA2DS2-VASc -HS scores. Patients were divided into two groups: those with STR> 70 % and those without STR> 70. Predictors of STR failure were determined by multivariate regression analysis.

Results: Multiple regression analysis showed that CHA2DS2-VASc-HS score, Anterior STEMI, peak CK-MB level and symptom to percutaneous coronary intervention time were associated with development of STR failure in patients presenting with STEMI. ROC curve analyses showed that CHA₂DS₂-VASc and CHA2DS2-VASc -HS scores were significant predictors for STR failure.

Conclusion: CHA₂DS₂-VASc and CHA2DS2-VASc -HS scores predict STR failure in patients presenting STEMI.  

Keywords

• CHA2DS2-VASc scores,ST segment resolution,myocardial infarction

CHADS2-VASc skorunun primer percutan koroner girişim yapılan ST elevasyonlu miyokart enfarktüslü hastalarda ST segment rezolusyonunu öngörmedeki yararlılığı

Abstract

Amaç: Tıkalı koroner arterde hızlı koroner kan akımın sağlanması, ST yükselmeli miyokard infarktüsü (STEMI) tedavisinin temel amacıdır. Her ne kadar koroner kan akımı sağlanmış olsa da, çoğunlukla mikrovasküler düzeyde yetersiz miyokard reperfüzyonu çok sayıda hastada saptanmıştır. Elektrokardiyografik olarak işlem sonrası ST-segment rezolusyonunu (STR) ölçmek reperfüzyon başarısını değerlendirilmek için kolay ve iyi bir göstergedir. CHA2DS2-VASc risk skoru, valvüler olmayan AF hastalarında tromboembolizm riskini tahmin etmek için kullanılır. STEMI ile başvuran hastalarda STR yetersizliğinin gelişmesini öngörmedeki yararı bilinmemektedir. STEMI sonrası STR’ nun değerlendirilmesinde CHA2DS2-VASc skorunun prediktif değerinin araştırılması amaçlanmıştır.

Yöntem: CHA2DS2-VASc ve CHA2DS2-VASc -HS puanlarının prediktif değerini test etmek için klinik ve laboratuvar parametrelerini içeren modeller yapıldı. Hastalar STR>% 70 olan ve olmayan olarak iki gruba ayrılmıştır. STR başarısızlığının öngördürücüleri, çok değişkenli regresyon analizi ile belirlendi.

Bulgular: Çalışmada STR saptanmayan hastalarda CHA2DS2-VASc ve CHA2DS2-VASc-HS skorları anlamlı olarak yüksekti. Çoklu regresyon analizi, CHA2DS2-VASc-HS skoru, Anterior STEMI, pik CK-MB seviyesi ve perkütan koroner girişim zamanının STEMI ile başvuran hastalarda STR yetersizliği gelişimi ile ilişkili olduğunu gösterdi. ROC eğrisi analizi, CHA2DS2-VASc ve CHA2DS2-VASc –HS skorlarının STR başarısızlığı için öngördürücü olduğunu göstermiştir.

Sonuç: CHA2DS2-VASc ve CHA2DS2-VASc -HS skorları, STEMI sunan hastalarda STR yetmezliğini öngörmektedir. 

Keywords

• CHA2DS2-VASc skoru,ST segment rezolusyonu,miyokart enfarktüsü

References

1. 1. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal 2018:ehy394-ehy394.
2. 2. Brener SJ, Dizon JM, Mehran R, et al. Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: analysis from the HORIZONS-AMI trial. American heart journal 2013;166:676-683.
3. 3. Sarkar A, Lee JJ. TIMI Grade Flow StatPearls. Treasure Island (FL), 2018.
4. 4. Somitsu Y, Nakamura M, Degawa T, et al. Prognostic value of slow resolution of ST-segment elevation following successful direct percutaneous transluminal coronary angioplasty for recovery of left ventricular function. The American journal of cardiology 1997;80:406-410.
5. 5. Sutton A, Campbell P, Grech E, et al. Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis. Heart 2000;84:197-204.
6. 6. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893-2962.
7. 7. Kilic S, Kocabas U, Can LH, et al. Predictive value of CHA2DS2-VASc and CHA2DS2-VASc-HS scores for failed reperfusion after thrombolytic therapy in patients with ST-elevation myocardial ınfarction. Cardiology journal 2013.
8. 8. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. European heart journal 2012;33:2551-2567.

9. 9. Lee A, Sadick N, Ng A, et al. Prognostic implication of ST‐segment resolution following primary percutaneous transluminal coronary angioplasty for ST‐elevation acute myocardial infarction. Internal medicine journal 2004;34:551-556.
10. 10. Members ATF, Steg PG, James SK, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European heart journal 2012;33:2569-2619.
11. 11. Folland ED, Parisi AF. Noninvasive evaluation of left ventricular function: the ejection fraction. Compr Ther 1979;5:47-54.
12. 12. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988:837-845.
13. 13. Bozbay M, Uyarel H, Cicek G, et al. CHA2DS2-VASc score predicts in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were undergoing primary percutaneous coronary intervention. Clinical and Applied Thrombosis/Hemostasis 2017;23:132-138.
14. 14. Cetin M, Cakici M, Zencir C, et al. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. The American journal of cardiology 2014;113:950-956.
15. 15. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010;137:263-272.
16. 16. Tousoulis D, Antoniades C, Stefanadis C. Assessing inflammatory status in cardiovascular disease. Heart 2007;93:1001-1007.
17. 17. Yilmaz S, Akboga MK, Aras D, et al. Evaluation of the predictive value of CHA2DS2-VASc score for In-Stent Restenosis. Angiology 2018;69:38-42.
18. 18. Woo JS, Cho JM, Kim SJ, et al. Combined assessments of biochemical markers and ST-segment resolution provide additional prognostic information for patients with ST-segment elevation myocardial infarction. Korean circulation journal 2011;41:372-378.
19. 19. Iwakura K, Ito H, Ikushima M, et al. Association between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarction. Journal of the American College of Cardiology 2003;41:1-7.
20. 20. Marfella R, Esposito K, Giunta R, et al. Circulating adhesion molecules in humans: role of hyperglycemia and hyperinsulinemia. Circulation 2000;101:2247-2251.21. Booth G, Stalker TJ, Lefer AM, et al. Elevated ambient glucose induces acute inflammatory events in the microvasculature: effects of insulin. American Journal of Physiology-Endocrinology And Metabolism 2001;280:E848-E856.
21. 22. Engler RL, Dahlgren MD, Morris DD, et al. Role of leukocytes in response to acute myocardial ischemia and reflow in dogs. American Journal of Physiology-Heart and Circulatory Physiology 1986;251:H314-H323.
22. 23. Ota S, Tanimoto T, Orii M, et al. Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction. Journal of cardiology 2015;65:272-277.
23. 24. Ndrepepa G, Tiroch K, Fusaro M, et al. 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. Journal of the American College of Cardiology 2010;55:2383-2389.
24. 25. Wu KC, Zerhouni EA, Judd RM, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998;97:765-772.
25. 26. Tang EW, Wong C-K, Herbison P. Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. American heart journal 2007;153:29-35.
26. 27. Mrdovic I, Savic L, Krljanac G, et al. Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention. The RISK-PCI score. International journal of cardiology 2013;162:220-227.
27. 28. Roffi M, Patrono C, Collet J-P, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European heart journal 2016;37:267-315.