Shaikh Abdul Hakeem, Kumar Rajesh, Ammar Ali, Hussain Afzal, Mengal Muhammad Naeem, Khan Kamran Ahmed, Qayyum Danish, Sial Jawaid Akbar, Saghir Tahir, Karim Musa
National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
J Cardiovasc Thorac Res. 2022;14(2):122-127. doi: 10.34172/jcvtr.2022.19. Epub 2022 Jun 25.
Slow flow/no reflow (SF/NR) phenomenon during emergency percutaneous revascularization is a feared complication associated with increased risk of adverse outcomes. CHA DS -VASc score has been proposed for the risk stratification but a very limited evidences are available regarding the accuracy of this system. Therefore, we conducted this study to assess the predictive value of CHA DS -VASc score for predicting SF/NR phenomenon during primary percutaneous coronary intervention (PCI). This analytical cross-sectional study included 596 consecutive patients undergoing PCI for STEMI at a tertiary care cardiac center of Karachi, Pakistan. Baseline -VASc sore was calculated and development of SF/NR phenomenon during primary PCI was recorded. Predictive value of the score was assessed through area under the curve (AUC) of receiver operating characteristic curve analysis and sensitivity and specificity were computed. Logistic regression analysis was performed to assess the predictive strength of the score. A total of 596 patients were included, mean age was 56.28±11.44 years, and 75.7%(451) were male. The slow/no reflow phenomenon during the procedure was observed in 36.6%(218) of the patients. CHA DS -VASc≥2 was observed in 50.2%(299) of the patients. The CHA DS -VASc score was significantly higher in SF/NR patients, 2.06±1.25 vs. 1.37±1.33; <0.001. The AUC of CHA DS -VASc score was 0.652 [0.607-0.696], CHA DS -VASc≥2 had sensitivity and specificity of 65.6% [58.9% to 71.9%] and 58.3% [53.6% to 63.7%] respectively for predicting SF/NR. CHA DS -VASc≥2 was insignificant on multivariate with odds ratio of 1.48 [0.72 -3.04]; =0.283. CHA DS -VASc risk stratification system has moderate discriminating power for the stratification of SF/NR phenomenon during primary PCI.
急诊经皮血管重建术中的慢血流/无复流（SF/NR）现象是一种令人担忧的并发症，与不良结局风险增加相关。CHA DS -VASc评分已被用于风险分层，但关于该系统准确性的证据非常有限。因此，我们开展了这项研究，以评估CHA DS -VASc评分在预测直接经皮冠状动脉介入治疗（PCI）期间SF/NR现象方面的预测价值。这项分析性横断面研究纳入了巴基斯坦卡拉奇一家三级心脏护理中心连续596例因ST段抬高型心肌梗死（STEMI）接受PCI的患者。计算基线CHA DS -VASc评分，并记录直接PCI期间SF/NR现象的发生情况。通过受试者工作特征曲线分析的曲线下面积（AUC）评估该评分的预测价值，并计算敏感性和特异性。进行逻辑回归分析以评估该评分的预测强度。共纳入596例患者，平均年龄为56.28±11.44岁，75.7%（451例）为男性。36.6%（218例）的患者在手术过程中出现了慢血流/无复流现象。50.2%（299例）的患者CHA DS -VASc≥2。SF/NR患者的CHA DS -VASc评分显著更高，为2.06±1.25 vs. 1.37±1.33；P<0.001。CHA DS -VASc评分的AUC为0.652 [0.607 - 0.696]，CHA DS -VASc≥2预测SF/NR的敏感性和特异性分别为65.6% [58.9%至71.9%]和58.3% [53.6%至63.7%]。在多变量分析中，CHA DS -VASc≥2无显著意义，优势比为1.48 [0.72 - 3.04]；P = 0.283。CHA DS -VASc风险分层系统在直接PCI期间对SF/NR现象的分层具有中等鉴别能力。
