CHA2DS2-VASc Score and Brachial Artery Flow Mediated Dilation (FMD) as Predictors for No Reflow Phenomenon in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention (PCI)

Abstract

the setting of primary PCI, no-reflow is better defined as suboptimal reperfusion of the myocardium supplied by the IRA without mechanical obstruction of the epicardial coronary artery. Angiographic no-reflow is known as TIMI less than III or MBG less than II and it occurs in around 11-41% of all primary PCI cases. Studies showed that no-reflow had led to a high rate of MACE after primary PCI as a revascularization strategy. Several trials tried to study the various predictors of no-reflow. Thus, several protocols could be applied to prevent no-reflow occurrence. The CHA2DS2 VASc scoring system is often utilized to anticipate the thrombo-embolic consequences in AF patients, especially non valvular AF. The parameters of this score are underlying causes for atherosclerosis and microvascular dysfunction similar to common risk factors of the no-reflow phenomenon. Appreciation of the vascular endothelium in the progression of atherosclerosis has contributed to the establishment of invasive and non-invasive methods for assessing various aspects of endothelial function. One of the most common assessments of endothelial function is the flow-mediated dilation (FMD) of the peripheral arteries, particularly the brachial artery. We attempted to assess the preprocedural CHA2DS2 VASc score and endothelial dysfunction in patients with STEMI undergoing primary PCI as predictors of no-reflow. We thus evaluated the clinical characteristics, angiographic findings, CHA2DS2 VASc score, and brachial artery FMD among patients with STEMI treated by primary PCI as a reperfusion protocol in Ain Shams University hospitals. Each patient was exposed to history taking, general and local examination, lab investigations were ordered, TTE was done, the brachial artery FMD% was measured, and the angiography results of the primary PCI were assessed using TIMI thrombus scale, TIMI flow grade, and MBG. Inpatient Follow up of the patients for mortality, heart failure, recurrent ischemic attacks, serious arrhythmia, and need for revascularization. The median FMD percent was higher with considerable statistical significance in patients with TIMI III flow and MBG≥ II (p-value =0.000 for both) in this study, while there was no significant relationship between FMD percent and TIMI thrombus grade (p-value=0.329) This study also found that the median CHA2DS