Clinical cardiology · 2026
Predictive Ability of the CHA2DS2-VA Score for No-Reflow Phenomenon in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI.
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Sun Ying, Ren Jian, Wang Wei, Wang Chunsong, Liu Min, Liu Jiahui, Qi Xuewen, Yao Hengchen
Аннотация
BACKGROUND: No-reflow phenomenon (NRP) frequently complicates ST-elevation myocardial infarction (STEMI). This study evaluated the CHA2DS2-VA score (CV score) as a predictor of NRP in STEMI patients undergoing primary PCI.
METHODS: A total of 725 STEMI patients were retrospectively enrolled and stratified by median of CV score (≤ 2 vs. > 2). The predictive ability of the CV score for NRP was assessed using logistic regression, receiver operating characteristic analysis, and DeLong tests.
RESULTS: NRP incidence was higher in the high CV score group (15.2% vs. 8.7%, p = 0.007). The CV score predicted NRP overall (adjusted OR: 1.295, p = 0.002), but this effect was confined to females (AOR: 1.597, p = 0.002), with no significant association in males. Area under the curve value (AUC) of the CV score for predicting NRP was 0.613 in all patients (38.8% sensitivity and 79.1% specificity, p = 0.001) and 0.673 in females (78.1% sensitivity and 47.6% specificity, p = 0.002). A significant sex × CV score interaction (p = 0.017) confirmed sex-modified predictive value. DeLong tests combining the CV score with laboratory markers improved prediction in males but not females.
CONCLUSION: The CV score is a sex-specific predictor of NRP in STEMI, with predictive value in females but not males. These findings support a tailored risk stratification approach: using the CV score alone for female patients, while integrating laboratory and procedural markers for male patients.
METHODS: A total of 725 STEMI patients were retrospectively enrolled and stratified by median of CV score (≤ 2 vs. > 2). The predictive ability of the CV score for NRP was assessed using logistic regression, receiver operating characteristic analysis, and DeLong tests.
RESULTS: NRP incidence was higher in the high CV score group (15.2% vs. 8.7%, p = 0.007). The CV score predicted NRP overall (adjusted OR: 1.295, p = 0.002), but this effect was confined to females (AOR: 1.597, p = 0.002), with no significant association in males. Area under the curve value (AUC) of the CV score for predicting NRP was 0.613 in all patients (38.8% sensitivity and 79.1% specificity, p = 0.001) and 0.673 in females (78.1% sensitivity and 47.6% specificity, p = 0.002). A significant sex × CV score interaction (p = 0.017) confirmed sex-modified predictive value. DeLong tests combining the CV score with laboratory markers improved prediction in males but not females.
CONCLUSION: The CV score is a sex-specific predictor of NRP in STEMI, with predictive value in females but not males. These findings support a tailored risk stratification approach: using the CV score alone for female patients, while integrating laboratory and procedural markers for male patients.