CHA2DS2-VASc score as a predictor of no-reflow phenomenon after saphenous vein graft percutaneous coronary intervention in patients with non–ST-segment elevation acute coronary syndromes

Abstract

Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) is associated with an increased risk of complications, particularly no‑reflow phenomenon and distal embolization due to low patency rates. The CHA2DS2‑VASc score is a clinical risk stratification tool used to predict thromboembolism events especially in patients with nonvalvular atrial fibrillation.

Aims: The aim of this study was to investigate the relationship between the CHA2DS2‑VASc score and no‑reflow phenomenon after SVG PCI in patients with non–ST‑segment elevation acute coronary syndromes (NSTE‑ACS).

Methods: In this study, we included 268 patients diagnosed with NSTE‑ACS who underwent PCI for SVG disease in our tertiary cardiovascular center. Patients were divided into 2 groups: group 1 without no‑‑reflow phenomenon (n = 190) and group 2 with no‑reflow phenomenon (n = 78) following the intervention, and then compared based on CHA2DS2‑VASc scores.

Results: The CHA2DS2‑VASc score (P < 0.001) was significantly higher in group 2, even though no significant difference regarding atrial fibrillation was observed between the study groups. The CHA2DS2‑VASc score (P < 0.001), degenerated saphenous vein graft (P = 0.006), and intraluminal thrombus (P < 0.001) were found to be independent predictors of no‑reflow phenomenon. Receiver operating characteristics analysis showed that a CHA2DS2‑VASc score of 4 predicted no‑reflow phenomenon with 67.9% sensitivity and 69.3% specificity.

Conclusions: Our findings suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing SVG interventions. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before SVG interventions in patients with NSTE‑ACS.