Prediction of angiographic (TIMI GRADE) blood flow using the novel CHA2DS2-VASC-HSF score in patients with STEMI

Abstract

Background: The CHA2DS2-VASc-HSF score, a novel risk stratification tool, has been proposed to predict angiographic outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to evaluate the predictive value of the CHA2DS2-VASc-HSF score in relation to the angiographic Thrombolysis in Myocardial Infarction (TIMI) blood flow grade. Methods: This cross-sectional study included 100 patients with acute STEMI admitted to the Cardiology Department at Benha University Hospitals and Health Insurance Hospitals from November 2022 to November 2023. All patients underwent PPCI within 12 hours of symptom onset. The CHA2DS2-VASc-HSF score was calculated for each patient. Angiographic TIMI flow grades were assessed post-PPCI, and the association between CHA2DS2-VASc-HSF scores and TIMI grades was analyzed. Results: Among the 100 STEMI patients, 16 experienced the no-reflow phenomenon, while 84 maintained normal or slow coronary blood flow. The CHA2DS2-VASc-HSF score was significantly higher in the no-reflow group compared to the normal/slow flow group (4.44±1.82 vs. 2.44±1.57, p < 0.001). The CHA2DS2-VASc-HSF score demonstrated the highest predictive accuracy for no-reflow with an area under the curve (AUC) of 0.868, sensitivity of 93.75%, and specificity of 66.67% at a cutoff value >2. Multivariate logistic regression analysis identified CK-MB levels, Killip classification, multivessel disease, stent length, and tirofiban infusion as independent predictors of no-reflow. Conclusion: The CHA2DS2-VASc-HSF score is a robust predictor of the no-reflow phenomenon in STEMI patients undergoing PPCI. Its high sensitivity and moderate specificity suggest its potential utility in clinical practice to identify high-risk patients and tailor therapeutic strategies accordingly.