Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China.
Medicine (Baltimore). 2021 May 28;100(21):e26162. doi: 10.1097/MD.0000000000026162.
ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) have a higher incidence of slow-flow/no-reflow (SF-NR) phenomenon during primary percutaneous coronary intervention (PPCI) than those with single vessel disease. Currently, no effective tools exist to predict the risk of SF-NR in this population. The present study aimed to evaluate whether CHA2DS2-VASc score can be used as a simple tool to predict this risk.This study consecutively included STEMI patients hospitalized in Beijing Anzhen Hospital from January 2005 to January 2015. Among these patients, 1032 patients with MVD were finally enrolled. Patients were divided into SF-NR (+) group and SF-NR (-) group according to whether SF-NR occurred during PPCI. SF-NR was defined as the thrombolysis in myocardial infarction (TIMI) grade ≤2.There were 134 patients (13%) in the SF-NR (+) group. Compared with the SF-NR (-) group, patients in the SF-NR (+) group are elder, with lower left ventricular ejection fraction and higher CHA2DS2-VASc score. Multiple logistic regression analysis indicated that CHA2DS2-VASc score ≥3 (odds ratio [OR], 2.148; 95% confidence interval [CI], 1.389-3.320; P = .001), current smoking (OR, 1.814; 95% CI, 1.19-2.764; P = .006), atrial fibrillation (OR, 2.892; 95% CI, 1.138-7.350; P = .03), complete revascularization (OR, 2.307; 95% CI, 1.202-4.429; P = .01), and total length of stents ≥40 mm (OR, 1.482; 95% CI, 1.011-2.172; P = .04) were independent risk factors of SF-NR. The incidence of SF-NR in patients with CHA2DS2-VASc score ≥3 was 1.7 times higher than that in patients with CHA2DS2-VASc score <3. Additionally, patients with CHA2DS2-VASc score ≥3 plus ≥2 risk factors have 3 times higher incidence of SF-NR than those with CHA2DS2-VASc score ≥3 plus 0 to 1 risk factor.CHA2DS2-VASc score ≥3 can be used as a simple and sensitive indicator to predict SF-NR phenomenon and guide the PPCI strategy in STEMI patients with MVD.
ST 段抬高型心肌梗死（STEMI）合并多支血管病变（MVD）患者行直接经皮冠状动脉介入治疗（PPCI）时发生慢血流/无复流（SF-NR）现象的风险高于单支血管病变患者。目前，尚无有效的工具可以预测此类人群 SF-NR 的风险。本研究旨在评估 CHA2DS2-VASc 评分是否可用作预测这种风险的简单工具。
本研究连续纳入 2005 年 1 月至 2015 年 1 月期间在北京安贞医院住院的 STEMI 患者。其中，最终纳入 1032 例 MVD 患者。根据 PPCI 期间是否发生 SF-NR，将患者分为 SF-NR（+）组和 SF-NR（-）组。SF-NR 定义为心肌梗死溶栓治疗（TIMI）血流分级≤2 级。SF-NR（+）组患者 134 例（13%）。与 SF-NR（-）组相比，SF-NR（+）组患者年龄较大，左心室射血分数较低，CHA2DS2-VASc 评分较高。多因素 logistic 回归分析表明，CHA2DS2-VASc 评分≥3（比值比[OR]，2.148；95%置信区间[CI]，1.389-3.320；P=0.001）、当前吸烟（OR，1.814；95%CI，1.19-2.764；P=0.006）、心房颤动（OR，2.892；95%CI，1.138-7.350；P=0.03）、完全血运重建（OR，2.307；95%CI，1.202-4.429；P=0.01）和支架总长度≥40mm（OR，1.482；95%CI，1.011-2.172；P=0.04）是 SF-NR 的独立危险因素。CHA2DS2-VASc 评分≥3 的患者 SF-NR 发生率是 CHA2DS2-VASc 评分<3 的患者的 1.7 倍。此外，CHA2DS2-VASc 评分≥3 且具有≥2 个危险因素的患者发生 SF-NR 的风险是 CHA2DS2-VASc 评分≥3 且具有 0 至 1 个危险因素的患者的 3 倍。
CHA2DS2-VASc 评分≥3 可作为预测 STEMI 合并 MVD 患者 SF-NR 现象的简单、敏感指标，并指导 PPCI 策略。
