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 CHA2DS2-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. CHA2DS2-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. Results. The CHA2DS2-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(−) (mean CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score are independently associated with spontaneous reperfusion.