The Impact of Lesion Complexity and the CHA2DS2-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background. In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). Objective. The present study aimed to determine the impact of lesion complexity and the CHA(2)DS(2)-VASc score on SR in patients with STEMI. Methods. A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(-) (n = 1402), according to their initial angiography and SR status. CHA(2)DS(2)-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. Results. The CHA(2)DS(2)-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(-) (mean CHA(2)DS(2)-VASc, 1.36 +/- 0.64 vs. 2.01 +/- 0.80, p < 0.001; mean SYNTAX score, 15.51 +/- 5.94 vs. 17.08 +/- 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA(2)DS(2)-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(-) (0% vs. 6.7%, p < 0.001). Conclusion. Our study demonstrated that lesion complexity and the CHA(2)DS(2)-VASc score are independently associated with spontaneous reperfusion.