October 1, 2022DiagnosticsOpen Access

The CHA2DS2-VASc Score Predicts New-Onset Atrial Fibrillation and Hemodynamic Complications in Patients with ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

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Why the study?

Existing STEMI risk scores focus on acute-phase factors, and no score had been evaluated specifically to predict STEMI-related arrhythmic and hemodynamic complications based on chronic risk factor burden.

Does the CHA2DS2-VASc score predict new-onset atrial fibrillation and hemodynamic complications in STEMI patients treated by primary PCI?

Structured PICO

Does the CHA2DS2-VASc score predict new-onset atrial fibrillation and hemodynamic complications in STEMI patients treated by primary PCI?

Population

839 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary interventions (pPCI)

Intervention

CHA2DS2-VASc score assessment

Outcome

STEMI-related arrhythmic (new-onset atrial fibrillation, ventricular tachycardia/fibrillation) and hemodynamic (cardiogenic shock, asystole) complicationshard clinical

The CHA2DS2-VASc score, alongside the GRACE score, independently predicts new-onset atrial fibrillation and hemodynamic complications in STEMI patients undergoing primary PCI.

Implication

May support CHA2DS2-VASc risk stratification in STEMI; leaves open prospective validation and impact on management.

Abstract

Arrhythmic and hemodynamic complications related to ST-segment elevation myocardial infarction (STEMI) represent a major clinical challenge. Several scores have been developed to predict mortality in STEMI. However, those scores almost exclusively include factors related to the acute phase of STEMI, and no score has been evaluated to date for its ability to specifically predict arrhythmic and hemodynamic complications. We, thus, aimed to assess the ability of chronic risk factors burden, as expressed by the CHA2DS2-VASc score, to predict STEMI-related arrhythmic and hemodynamic complications. Data were collected from 839 consecutive STEMI patients treated by primary percutaneous coronary interventions (pPCI). CHA2DS2-VASc and GRACE scores were calculated for all patients, and their ability to predict STEMI-related arrhythmic (i.e., new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation) and hemodynamic (i.e., cardiogenic shock, asystole) complications was assessed in univariate and multiple regression analysis. Arrhythmic and hemodynamic complications occurred in 14.8% and 10.2% of patients, respectively. Although the GRACE score outweighed the CHA2DS2-VASc score in the ability to predict STEMI-related hemodynamic complications (p < 0.0001), both scores had a similar predictive value for STEMI-related new-onset AF (p = 0.20), and both remained independent predictors of new-onset AF and of hemodynamic complications in the multiple regression analyses. A CHA2DS2-VASc score > 2 points independently predicted new-onset AF (p < 0.01) and hemodynamic complications (p = 0.04). Alongside the GRACE score, the CHA2DS2-VASc score independently predicted new-onset AF and hemodynamic complications in STEMI patients treated by pPCI. These data suggest that a combination of acute and chronic risk factors could provide additional benefit in identifying patients at risk of STEMI-related complications, who could benefit from closer follow-up and more intensive prophylactic and therapeutic strategies.