Predictive value of CHA2DS2-VASc and CHA2DS2-VASc-HS scores for failed reperfusion after thrombolytic therapy in patients with ST-segment elevation myocardial infarction
Articles > Article · 2019
Authors: Kilic, Salih; Doctor Ersin Aslan Research and Training Hospital, Şahinbey, Gaziantep, Turkey, Kocabas, Umut; Soma State Hospital, Manisa, Turkey, Can, Levent Hurkan; Ege University Faculty of Medicine, İzmir, Turkey, Yavuzgil, Oğuz; Ege University Faculty of Medicine, İzmir, Turkey, Çetin, Mustafa; Doctor Ersin Aslan Research and Training Hospital, Şahinbey, Gaziantep, Turkey, Zoghi, Mehdi; Ege University Faculty of Medicine, İzmir, Turkey
Cardiology Journal; Vol 26, No 2 (2019); 169-175, International, 2019
Summary
Background: Thrombolytic therapy is recommended for patients with acute ST-segment elevation myo- cardial infarction (STEMI) who cannot undergo primary percutaneous coronary intervention within the first 120 min. The aim of this study was to demonstrate the value of CHA 2 DS 2 -VASc and CHA 2 DS 2 - -VASc-HS scores in predicting failed reperfusion in STEMI patients treated with thrombolytic therapy. Methods: A total of 537 consecutive patients were enrolled in the study; 139 had failed thrombolysis while the remaining 398 fulfilled the criteria for successful thrombolysis. Thrombolysis failure was defined with the lack of symptom relief, < 50% ST resolution-related electrocardiography within 90 min from initiation of the thrombolytic therapy, presence of hemodynamic or electrical instability or in-hospital mortality. CHA 2 DS 2 -VASc and CHA 2 DS 2 -VASc-HS scores, which incorporate hyperlipi- demia, smoking, switches between female and male gender, were previously shown to be markers of the severity of coronary artery disease (CAD). Results: History of hypertension, diabetes mellitus, hyperlipidemia, heart failure, smoking, and CAD were significantly common in failed reperfusion patients (for all; p < 0.05). For prediction of failed rep- erfusion, the cut-off value of CHA 2 DS 2 -VASc score was ≥ 2 with a sensitivity of 80.90% and a specificity of 41.01% (area under curve [AUC] 0.660 ; 95% confidence interval [CI] 0.618–0.700; p < 0.001) and the cut-off value of CHA 2 DS 2 -VASc-HS score was ≥ 3 with a sensitivity of 76.13% and a specificity of 67.63% (AUC 0.764; 95% CI 0.725–0.799; p < 0.001). The CHA 2 DS 2 -VASc-HS score was found to be statistically and significantly better than CHA 2 DS 2 -VASc score to predict failed reperfusion (p < 0.001). Conclusions: The findings suggest that the CHA 2 DS 2 -VASc and especially CHA 2 DS 2 -VASc-HS scores could be considered as predictors of risk of failed reperfusion in STEMI patients.