الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
I
n the setting of primary PCI, no-reflow is better defined as suboptimal reperfusion of the myocardium supplied by the IRA without mechanical obstruction of the epicardial coronary artery.
Angiographic no-reflow is known as TIMI less than III or MBG less than II and it occurs in around 11-41% of all primary PCI cases.
Studies showed that no-reflow had led to a high rate of MACE after primary PCI as a revascularization strategy.
Several trials tried to study the various predictors of no-reflow. Thus, several protocols could be applied to prevent no-reflow occurrence.
The CHA2DS2 VASc scoring system is often utilized to anticipate the thrombo-embolic consequences in AF patients, especially non valvular AF. The parameters of this score are underlying causes for atherosclerosis and microvascular dysfunction similar to common risk factors of the no-reflow phenomenon.
Appreciation of the vascular endothelium in the progression of atherosclerosis has contributed to the establishment of invasive and non-invasive methods for assessing various aspects of endothelial function. One of the most common assessments of endothelial function is the flow-mediated dilation (FMD) of the peripheral arteries, particularly the brachial artery.
We attempted to assess the preprocedural CHA2DS2 VASc score and endothelial dysfunction in patients with STEMI undergoing primary PCI as predictors of no-reflow.
We thus evaluated the clinical characteristics, angiographic findings, CHA2DS2 VASc score, and brachial artery FMD among patients with STEMI treated by primary PCI as a reperfusion protocol in Ain Shams University hospitals.
Each patient was exposed to history taking, general and local examination, lab investigations were ordered, TTE was done, the brachial artery FMD% was measured, and the angiography results of the primary PCI were assessed using TIMI thrombus scale, TIMI flow grade, and MBG.
Inpatient Follow up of the patients for mortality, heart failure, recurrent ischemic attacks, serious arrhythmia, and need for revascularization.
The median FMD percent was higher with considerable statistical significance in patients with TIMI III flow and MBG≥ II (p-value =0.000 for both) in this study, while there was no significant relationship between FMD percent and TIMI thrombus grade (p-value=0.329)
This study also found that the median CHA2DS VASc score was higher in patients with TIMI flow < III and MBG<II with significant statistical significance (p-value =0.000, 0.000 respectively) but no significant relation between the score and the TIMI thrombus (p-value=0.401).
The current study found a significant negative association (p =0.000) between pre-procedural FMD% and CHA2DS VAS value (p =0.000).
The current study failed to find statistical significance between the patients’ CHA2DS VASc score and the incidence of MACE during the hospital stay (p =0.290).
The current study also didn’t a find significant correlation between the patients’ brachial artery FMD and the occurrence of MACE throughout their hospital stay (p =0.685).
Conclusion
CONCLUSION
According to the findings of this study, it can be concluded that:
• In patients with STEMI treated with primary PCI, the preprocedural CHA2DS2 VASc score may predict which patients are at high risk of no-reflow.
• In patients with STEMI treated with primary PCI, the preprocedural FMD value may predict which patients are at high risk of no-reflow.
• CHA2DS2 VASc score has a significant correlation with FMD percentages among STEMI patients.
• CHA2DS2 VASc score and FMD percentage of STEMI patients could not predict the inpatient MACE.
Recommendations
RECOMMENDATIONS
• longer follow-up is needed to examine the predictive usefulness of the CHA2DS2 VASc score for no-reflow.
• Larger number of patients is required to obtain more statistically significant data as regards the predictors of no-reflow.
• Multiple centers’ experiences are required to obtain more statistically significant data as regards the predictors of no-reflow.
• Newer and more time-saving noninvasive methods are needed to rapidly assess the endothelial function of patients with acute STEMI before primary PCI.