Department of Cardiology, Kahramankazan Hamdi Eriş State Hospital, Ankara, Turkey.
Department of Cardiology, Ankara Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey.
Angiology. 2020 May;71(5):411-416. doi: 10.1177/0003319720903585. Epub 2020 Feb 7.
Acute stent thrombosis is an important complication of stent implantation. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age between 65 and 74 years, female gender) score incorporates important cardiovascular (CV) risk factors and predicts prognosis in various CV conditions. We evaluated the value of the CHA2DS2-VASc score in predicting acute stent thrombosis (ie, thrombosis during 24 hours after stent placement) in patients undergoing primary percutaneous intervention for ST-segment elevated myocardial infarction. Patients with intraprocedural stent thrombosis and complications were excluded; 48 (2.1%) of 2732 patients had acute stent thrombosis according to our definition. Median CHA2DS2-VASc score was significantly higher in this stent thrombosis group. Cumulative acute stent thrombosis rates were 0.51% for CHA2DS2-VASc score ≤1, 1.55% for ≤2, 1.80% for ≤3, 2.00% for ≤4, 2.17% for ≤5, and 2.19% for ≤6. The CHA2DS2-VASc score (odds ratio = 1.390, 95% confidence interval = 1.118-1.728; = .003) was an independent predictor of acute stent thrombosis. The CHA2DS2-VASc score ≤1 predicted the absence of the acute stent thrombosis with 91% specificity and 36% sensitivity. Further studies are needed to establish the value of this finding in the context of current clinical practice.
急性支架血栓形成是支架植入的一个重要并发症。CHA2DS2-VASc（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、既往卒中、血管疾病、65-74 岁之间、女性）评分纳入了重要的心血管（CV）危险因素，并预测了各种 CV 情况下的预后。我们评估了 CHA2DS2-VASc 评分在预测 ST 段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗（PCI）后急性支架血栓形成（即支架置入后 24 小时内发生血栓形成）中的价值。排除了术中支架血栓形成和并发症的患者；根据我们的定义，2732 例患者中有 48 例（2.1%）发生急性支架血栓形成。在该支架血栓形成组中，中位数 CHA2DS2-VASc 评分明显较高。CHA2DS2-VASc 评分≤1 者急性支架血栓形成的累积发生率为 0.51%，≤2 者为 1.55%，≤3 者为 1.80%，≤4 者为 2.00%，≤5 者为 2.17%，≤6 者为 2.19%。CHA2DS2-VASc 评分（比值比=1.390，95%置信区间=1.118-1.728；P=0.003）是急性支架血栓形成的独立预测因子。CHA2DS2-VASc 评分≤1 预测急性支架血栓形成的阴性率为 91%，敏感度为 36%。需要进一步的研究来确定这一发现在当前临床实践中的价值。
