CHA2DS2-VASc score, a simple clinical tool for early prediction of noreflow phenomenon in patients undergoing emergency percutaneous coronary revascularization

CHA2DS2-VASc score has been proposed for the risk stratification but a very limited evidences are available regarding the accuracy of this system. [...]we conducted this study to assess the predictive value of CHA2DS2-VASc score for predicting SF/NR phenomenon during primary percutaneous coronary intervention (PCI). Introduction The emergency percutaneous revascularization within 12 hours of onset of symptoms remains the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI).1, 2 A significant reduction in shortand long-term mortality of STEMI patients has been witnessed by virtue of technical as well as materialistic advancements in stent technology and pharmacological therapies.3, 4 However, microvascular obstruction in distal coronary artery resulting in poor myocardial perfusion, known as slow/no reflow (SF/NR) phenomenon, remains the common complication after primary percutaneous coronary intervention (PCI) with incidence rate ranging from 4 to 44%.5-8 It is found to be associated with increased risk of short- and long-term adverse events. Pathogenesis of the phenomenon is not clear but various mechanisms have been postulated such as microvascular spasm, distal micro-embolization of thrombus fragments, and endothelial swelling due to reperfusion and ischemic injury.9-11 Various studies have reported multiple patient related as well as system related factors as the potential predictors of SF/NR phenomenon,8, 11-14 but unfortunately accurate and reliable risk stratification of patients for SF/NR phenomenon remains a clinical challenge. [...]the CHA2DS2-VASc scoring system has reported to have good predictive value for prediction of SF/NR phenomenon, however, supported evidences are very limited and accuracy of the score greatly varies from one study to other with area under the curve (AUC) of 0.56 6 in one study and 0.83 7 in other. [...]this study was designed to assess the predictive value of CHA2DS2-VASc sore for predicting SF/NR phenomenon during primary PCI for patients with STEMI.