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Association of CHA2DS2-VASc score with thrombus burden in patients with acute myocardial infarction undergoing SVG-PCI

Zusammenhang zwischen CHA2DS2-VASc-Score und Thrombuslast bei Patienten mit akutem Myokardinfarkt und SVG-PCI

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Abstract

Background

The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA2DS2-VASc score is used to predict the risk of thromboembolic events in patients with nonvalvular atrial fibrillation. We aimed to evaluate the predictive role of the CHA2DS2-VASc score in the estimation of intracoronary thrombus burden in patients with acute myocardial infarction (AMI) who underwent SVG-PCI.

Methods

We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0–3) and high thrombus burden (HTB; TIMI 4 and 5).

Results

The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA2DS2-VASc scores (p < 0.001) compared with LTB patients. Univariate and multivariate regression analysis demonstrated that both CHA2DS2-VASc score (OR: 1.573, 95% CI: 1.153–2.147, p = 0.004) as a continuous variable and a binary cut-off level of the CHA2DS2-VASc score > 3 (OR: 3.876, 95% CI: 1.705–8.808, p = 0.001) were significantly associated with HTB. The ability of the CHA2DS2-VASc score to predict HTB burden was evaluated by receiver-operating characteristics analysis curve analysis. The optimum cut-off value of the CHA2DS2-VASc score for predicting HTB was 3 (with a sensitivity of 67.9% and a specificity of 69.3%) according to the Youden index.

Conclusion

The CHA2DS2-VASc score can be used as an easy practical tool to predict HTB in AMI patients undergoing SVG-PCI.

Zusammenfassung

Hintergrund

Die Verschlussrate für V.-saphena-Transplantate (SVG) innerhalb des ersten Jahres nach der Bypass-Operation liegt bei 15%. Zur Vorhersage des Risikos thromboembolischer Ereignisse bei Patienten mit nichtvalvulärem Vorhofflimmern wird der CHA2DS2-VASc-Score verwendet. Ziel der vorliegenden Arbeit war es, die prädiktive Bedeutung des CHA2DS2-VASc-Scores bei der Einschätzung der intrakoronaren Thrombuslast für Patienten mit akutem Myokardinfarkt (AMI) zu ermitteln, bei denen eine perkutane koronare Intervention (PCI) an einem SVG erfolgte.

Methoden

Retrospektiv wurden 221 Patienten untersucht, die wegen AMI stationär aufgenommen wurden und bei denen zwischen 2012 und 2018 am Department of Cardiology im Turkiye Yuksek Ihtisas Education and Research Hospital eine SVG-PCI durchgeführt wurde. Die Studienpopulation wurde entsprechend ihrem Thrombusgrad gemäß Thrombolysis in Myocardial Infarction (TIMI) in 2 Gruppen unterteilt: niedrige Thrombuslast (LTB; TIMI 0–3) und hohe Thrombuslast (HTB; TIMI 4 und 5).

Ergebnisse

In die Studie wurden 221 Patienten mit einem Durchschnittsalter von 63,3 ± 6,7 Jahren aufgenommen. Patienten mit HTB wiesen signifikant höhere CHA2DS2-VASc-Scores auf (p < 0,001) als LTB-Patienten. In der univariaten und multivariaten Regressionsanalyse zeigte sich, dass der CHA2DS2-VASc-Score (Odds Ratio, OR: 1,573; 95 %-Konfidenzintervall, 95 %-KI: 1,153–2,147; p = 0,004) als kontinuierliche Variable und auch ein binärer Grenzwert mit einem CHA2DS2-VASc-Score > 3 (OR: 3,876; 95 %-KI: 1,705–8,808; p = 0,001) in signifikanter Weise mit HTB assoziiert waren. Die Eignung des CHA2DS2-VASc-Scores zur Vorhersage der HTB wurde durch eine Kurvenanalyse mit Receiver-Operating-Characteristics-Analyse beurteilt. Der optimale Grenzwert für den CHA2DS2-VASc-Score zur Vorhersage von HTB betrug 3 (mit einer Sensitivität von 67,9 % und einer Spezifität von 69,3 %) gemäß Youden-Index.

Schlussfolgerung

Der CHA2DS2-VASc-Score kann als einfaches praktisches Instrument zur Vorhersage einer HTB bei AMI-Patienten, die mittels SVG-PCI behandelt werden, eingesetzt werden.

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Authors and Affiliations

  1. Department of Cardiology, Ankara City Hospital, Ankara, Turkey

    Orhan Maden MD, Özge Çakmak Karaaslan MD, İdris Yakut MD, Nezaket Merve Yaman MD, Kevser Gülcihan Balcı MD, Mehmet Timur Selçuk MD & Hatice Selçuk MD

  2. Department of Cardiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey

    Yücel Kanal MD

  3. Department of Cardiology, Kahramankazan State Hospital, Ankara, Turkey

    Hasan Can Könte MD

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O. Maden, Ö. Çakmak Karaaslan, Y. Kanal, İ. Yakut, N. M. Yaman, H. C. Könte, K. G. Balcı, M. T. Selçuk and H. Selçuk declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Maden, O., Çakmak Karaaslan, Ö., Kanal, Y. et al. Association of CHA2DS2-VASc score with thrombus burden in patients with acute myocardial infarction undergoing SVG-PCI. Herz 47, 456–464 (2022). https://doi.org/10.1007/s00059-021-05070-x

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