Predictive Ability of the CHA2DS2-VA Score for No-Reflow Phenomenon in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI

Abstract

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.