Key result
RCHA2DS2-VASc score ≥2 predicts STEMI no-reflow with ~83% sensitivity.
Why the study?
No-reflow occurs in 5% to 10% of STEMI patients after primary PCI and the prognostic value of the RCHA2DS2-VASc score including renal dysfunction for predicting no-reflow is unclear.
Does the RCHA2DS2-VASc score predict no-reflow phenomenon in patients with STEMI?
Observational (n=1,213)
Does the RCHA2DS2-VASc score predict no-reflow phenomenon in patients with STEMI?
p-value: p=<.001
The RCHA2DS2-VASc score is a simple and accessible tool that can predict the no-reflow phenomenon in patients with STEMI.
May support no-reflow risk stratification in STEMI; hypothesis-generating and requires prospective validation before practice change.
OBJECTIVE: No-reflow is a phenomenon that can arise due to factors such as distal embolization, microvascular occlusion, or prolonged myocardial ischemia and damage. It occurs in about 5% to 10% of patients after primary percutaneous coronary intervention. The CHA2DS2-VASc score can be easily calculated in daily practice and the components of this score are similar to common risk factors for no-reflow. Chronic renal disease generates a hypercoagulable state, which is associated with increased risk of no-reflow in cases of ST-segment elevation myocardial infarction (STEMI). A modified CHA2DS2-VASc score has been developed to include patients with renal dysfunction. The aim of this study was to investigate the prognostic significance of this scoring system, the RCHA2DS2-VASc score, in patients with no-reflow. METHODS: A total of 75 patients with no-reflow and 1138 patients without no-reflow after STEMI were retrospectively enrolled in this study. The CHA2DS2-VASc and RCHA2DS2-VASc scores of the two groups were compared. RESULTS: The median CHA2DS2-VASc score and the median RCHA2DS2-VASc score were significantly higher in the no-reflow group (p<.001, for both). There was a statistically significant difference between the groups in all of the components of the CHA2DS2-VASc score. An RCHA2DS2-VASc score of ≥2 was a predictor of no-reflow with a sensitivity of 83% and specificity of 62%. CONCLUSION: The RCHA2DS2-VASc score is a simple, inexpensive, and easily accessible score to predict no-reflow.
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A 2020 study conducted an observational in ST segment elevation myocardial infarction (n=1,213). RCHA2DS2-VASc score vs. CHA2DS2-VASc score was evaluated on No-reflow phenomenon (p=<.001). An RCHA2DS2-VASc score of ≥2 predicted no-reflow phenomenon in patients with ST-segment elevation myocardial infarction with a sensitivity of 83% and specificity of 62%.
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