All participants were subjected to detailed medical history and thorough clinical examination.ĬHA2DS2 VASc score was calculated for all participants by giving 1 point to previously established risk factors (congestive heart failure or left ventricular ejection fraction (LVEF) ≤ 40%, hypertension, diabetes mellitus, age 65–74, vascular disease and sex (female category)), age ≥ 75, and previous stroke or transient ischemic attack score 2 points. Study design was revised and approved by the local ethical committee (FMASU MD 396/2019) following declaration of Helsinki last updated 2008 and an informed written consent was obtained from each patient. Patients treated with fibrinolytic therapy, patients whose coronary anatomy was not eligible to perform PCI, patients with known chronic inflammatory diseases, and those who died during the PCI procedure were ruled out of the study. Patients were classified into two main groups according to the flow result after PCI, no-reflow group and a reflow group, the later was used as a control group. This is an observational cross-sectional case–control study in which we enrolled 150 patients who presented to a tertiary care university hospital with acute STEMI among period from January 2020 till June 2021. The flow-mediated dilation (FMD) of the brachial artery is one of the noninvasive endothelial function tests that reflect the endothelial health of the entire arterial system, including the coronary arteries. It incorporates traditional risk variables linked to atherosclerosis and consequent endothelial dysfunction, one of the underlying reasons for no-reflow. The CHA2DS2 VASc score is a clinical predictor of thromboembolic events in patients with non-valvular atrial fibrillation. So, no reflow is better to be early predicted and prevented to change the prognosis of primary PCI. Following primary PCI, no-reflow is related to various major adverse cardiac events. No-reflow constituted widely from 11 to 41% of all the patients presented with acute STEMI. In patients having ST-segment elevation myocardial infarction (STEMI), successful revascularization of the infarct-related vessel by primary percutaneous coronary intervention (PCI) doesn't always recover the micro-vascular tissue perfusion to its normal state 'No-reflow' is how this is actually described. Preprocedural CHA2DS2 VASc score and the brachial artery FMD can be used as predictors for the no-reflow phenomenon in patients with STEMI, undergoing primary PCI. Moreover, there was a significant negative correlation between CHA2DS VAS score and preprocedural FMD%, with the higher the score indicating lower FMD among cases ( p-value = 0.000). The no-reflow patients were older and had significantly higher body mass index (BMI), higher frequency of diabetes mellitus, hypertension, history of heart failure, dyslipidemia, Killip class IV on admission, thrombus grade V, multiple affected vessels, conventional stenting, and multiple stents placement, longer ischemic times, higher CHA2DS VASc score, and lower brachial artery FMD% ( p-values of < 0.05 for all). There were 39 (26%) patients in the no-reflow group and 111 (74%) in the reflow group. The CHA2DS2 VASc score was calculated and evaluation of endothelial function by measuring the brachial artery FDM% was done for each patient before the procedure. This study included 150 patients who presented with acute STEMI, underwent primary PCI, and were divided into two groups according to the flow result, reflow group and a no-reflow group. This study aimed to evaluate the preprocedural CHA2DS2 VASc score and the brachial artery flow-mediated dilation percentage (FMD%) as predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.

Despite the importance of early no-reflow prediction in cardiovascular medicine, noninvasive assessment is lacking. Following primary percutaneous coronary intervention (PCI), no-reflow is associated with a high rate of long-term unfavorable clinical outcomes.

Timi iii flow