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CHA2DS2-VASc score predicts intracoronary thrombus burden in patients with ST-elevation myocardial infarction

Objective: To evaluate the role of CHA2DS2-VASc score in predicting the intracoronary thrombus burden in patients with ST-Elevation Myocardial Infarction (STEMI).

Background: High intracoronary thrombus burden is associated with reduced procedural success, larger infarct size, and mortality after Primary Percutaneous Coronary Intervention (PPCI). Prediction of thrombus burden before PPCI might be useful by enabling the detection of patients at risk for these complications.

Methods: We retrospectively evaluated 164 consecutive patients who presented with STEMI within 12 h after the onset of chest pain between January 2015 and June 2016. PPCI was performed within 1 h after admission. Thrombus burden was graded according to Thrombolysis in Myocardial Infarction (TIMI) thrombus score. The patients were stratified into low (grades 1, 2 and 3) and high thrombus burden groups (grades 4 and 5). CHA2DS2-VASc score was calculated for each patient.

Results: Thrombus burden was low in 94 (57%) patients and high in 70 (43%) patients. CHA2DS2-VASc score was higher in patients with high thrombus burden compared to patients with low thrombus burden (4.41 ± 1.7 vs. 1.47 ± 1.1, p<0.001). Logistic regression analysis revealed that one-point increment in CHA2DS2VASc score was associated with three times higher risk of having high thrombus burden (odds ratio 3.28, 95% CI: 2.57-5.70). The area under the ROC curve for a cut-off value of CHA2DS2- VASc score>2 to predict high thrombus burden was 0.925, with a sensitivity of 91% and a specificity of 82%.

Conclusion: CHA2DS2-VASc score is a simple tool that predicts thrombus burden in STEMI patients undergoing PPCI.

Author(s): Sabri Seyis, Ozge Kurmus, Salih Kilic, Sezen Baglan Uzunget, Ebru Akgul Ercan