Predictive value of CHA2DS2-VASc and CHA2DS2-VASc-HS scores for failed reperfusion after thrombolytic therapy in patients with st-segment elevation myocardial infarction

Abstract

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 CHA2DS2-VASc and CHA2DS2--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. CHA2DS2-VASc and CHA2DS2-VASc-HS scores, which incorporate hyperlipidemia, 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 reperfusion, the cut-off value of CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc-HS score was found to be statistically and significantly better than CHA2DS2-VASc score to predict failed reperfusion (p < 0.001). Conclusions: The findings suggest that the CHA2DS2-VASc and especially CHA2DS2-VASc-HS scores could be considered as predictors of risk of failed reperfusion in STEMI patients.