Related Experiment Video
Updated: Oct 2, 2025
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
CHA2DS2 VASc score and brachial artery flow-mediated dilation as predictors for no-reflow phenomenon in patients with
Mohamed Ismail Rashed1, Mohamed Ayman Saleh2, Ehab Mohamed Elfekky2
1Department of Cardiology, Ain Shams University, 38 Ramsis Street, El Abbaseya, Cairo, Egypt. mohamedrashed@med.asu.edu.eg.
Insights
The preprocedural CHA2DS2 VASc score and brachial artery flow-mediated dilation (FMD%) can predict no-reflow after ST-segment elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PCI). Higher scores and lower FMD% indicate increased no-reflow risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Prediction Models
Background:
- No-reflow phenomenon post-primary percutaneous coronary intervention (PCI) is linked to poor long-term outcomes.
- Early prediction of no-reflow is crucial, yet noninvasive methods are limited.
- This study investigates preprocedural risk factors for no-reflow in acute ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To evaluate the CHA2DS2 VASc score as a predictor of no-reflow.
- To assess brachial artery flow-mediated dilation percentage (FMD%) for no-reflow prediction.
- To determine the utility of these noninvasive markers before primary PCI in STEMI patients.
Main Methods:
- 150 STEMI patients undergoing primary PCI were analyzed.
- CHA2DS2 VASc scores were calculated pre-PCI.
- Brachial artery FMD% was measured pre-PCI to assess endothelial function.
Main Results:
- 39% of patients experienced no-reflow.
- No-reflow patients had higher CHA2DS2 VASc scores and lower FMD% (p<0.05).
- A significant negative correlation existed between CHA2DS2 VASc score and FMD% (p=0.000).
Conclusions:
- Preprocedural CHA2DS2 VASc score is a valuable predictor of no-reflow.
- Brachial artery FMD% is a useful noninvasive marker for no-reflow risk.
- These markers can aid in risk stratification for STEMI patients undergoing primary PCI.
Background:
Following primary percutaneous coronary intervention (PCI), no-reflow is associated with a high rate of long-term unfavorable clinical outcomes. Despite the importance of early no-reflow prediction in cardiovascular medicine, noninvasive assessment is lacking. This study aimed to evaluate the preprocedural CHA2DS2 VASc score and the brachial artery flow-mediated dilation percentage (FMD%) as predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.
Results:
This study included 150 patients who presented with acute STEMI, underwent primary PCI, and were divided into two groups according to the flow result, reflow group and a no-reflow group. The CHA2DS2 VASc score was calculated and evaluation of endothelial function by measuring the brachial artery FDM% was done for each patient before the procedure. There were 39 (26%) patients in the no-reflow group and 111 (74%) in the reflow group. The no-reflow patients were older and had significantly higher body mass index (BMI), higher frequency of diabetes mellitus, hypertension, history of heart failure, dyslipidemia, Killip class IV on admission, thrombus grade V, multiple affected vessels, conventional stenting, and multiple stents placement, longer ischemic times, higher CHA2DS VASc score, and lower brachial artery FMD% (p-values of < 0.05 for all). Moreover, there was a significant negative correlation between CHA2DS VAS score and preprocedural FMD%, with the higher the score indicating lower FMD among cases (p-value = 0.000).
Conclusions:
Preprocedural CHA2DS2 VASc score and the brachial artery FMD can be used as predictors for the no-reflow phenomenon in patients with STEMI, undergoing primary PCI.
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:30Acute Coronary Syndrome III: Diagnostic Studies