The Relation Between CHA2DS2-VASc Score, Initial TIMI Flow Grades and In-Hospital Mortality in Patients Presenting
Funda Ozlem Pamuk1, Hatice Mediha Kına2, Esra Dönmez3
1Department of Cardiology, Ankara Bilkent City Hospital, Turkey.
Insights
The CHA2DS2-VASc score predicts poor initial coronary artery blood flow and in-hospital mortality in acute myocardial infarction (AMI) patients. Higher scores indicate increased risk for low flow and death.
Area of Science:
- Cardiology
- Clinical Risk Stratification
Background:
- The CHA2DS2-VASc score assesses stroke risk in atrial fibrillation but is also used for other cardiovascular conditions.
- Initial Thrombolysis in Myocardial Infarction (TIMI) flow is a critical determinant of outcomes in acute myocardial infarction (AMI).
Purpose of the Study:
- To investigate the association between the CHA2DS2-VASc score and initial TIMI flow in patients with AMI.
- To evaluate the CHA2DS2-VASc score's predictive value for in-hospital clinical outcomes, including mortality, in AMI patients.
Main Methods:
- Retrospective analysis of 750 patients hospitalized with a first diagnosis of AMI.
- Recording and comparison of initial and post-procedural TIMI flow grades.
- Analysis of CHA2DS2-VASc scores in relation to TIMI flow and in-hospital mortality.
Main Results:
- A higher CHA2DS2-VASc score was significantly associated with lower initial TIMI flow (TIMI 0-1).
- A CHA2DS2-VASc score of 3 was the optimal cut-off for predicting low initial TIMI flow.
- The CHA2DS2-VASc score was an independent predictor of in-hospital mortality, with a median score of 4 in non-survivors.
Conclusions:
- The CHA2DS2-VASc score is a valuable tool for predicting both initial coronary artery perfusion and in-hospital mortality in AMI patients.
- Elevated CHA2DS2-VASc scores identify AMI patients at higher risk for adverse outcomes, including poor initial flow and increased mortality.
Abstract:
The CHA2DS2-VASc score includes classical risk factors (e.g., Congestive heart failure/Left ventricle dysfunction, Hypertension, Age, Diabetes mellitus, Stroke/Transient ischemic attack/Thromboembolism, Vascular disease and Sex) for coronary artery disease. We investigated the association between initial thrombolysis in myocardial infarction (TIMI) flow of the culprit artery and CHA2DS2-VASc score and in-hospital clinical outcomes in patients presenting with acute myocardial infarction (AMI). Initial and postprocedural TIMI flow grades were recorded in patients hospitalized with first diagnosis of AMI. The initial TIMI flow grades and CHA2DS2VASC scores were compared with the post-procedural TIMI flow grades. Patients (n = 750) were included retrospectively; 56.7% was in the low flow (TIMI 0-1) and 43.3% was in the high flow (TIMI 2-3) group. The CHA2DS2-VASc score was higher (P < .001) in the low flow group. The best CHA2DS2-VASc score cut-off value was 3 to predict initial TIMI flow. Median CHA2DS2-VASc score was 4 in-hospital mortality group (P < .001) and this score was an independent predictor of in-hospital mortality. The CHA2DS2-VASc score was an independent predictor of low initial TIMI flow and in-hospital mortality. Patients with high preprocedural CHA2DS2-VASc tended to have low coronary flow grades and higher mortality rates.
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