The Relationship Between Cha2ds2-Vasc Scores And The Degree of TIMI Flow in Patients With Acute St-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention at Dr. Saiful Anwar Malang

Bayu Aji, Sasmojo Widito, Setyasih Anjarwani, Novi Kurnianingsih, Evit Ruspiono


Background: Suboptimal reperfusion of the compromised myocardium in the area of the culprit coronary arteries is one of the main problems associated with primary PCI that need reliable risk stratification methods to accurately predict the occurrence of decreased TIMI flow given its complex pathophysiology. Some parameters are included CHA2DS2-VASc score.

Objective: To understand the relationship between CHA2DS2-VASc and the decreased TIMI flow in STE-ACS patients who had underwent primary PCI at RSUD dr. Saiful Anwar Malang.

Material and Methods: The study was cohort retrospective with the inclusion criteria being all STE-ACS patients who underwent primary PCI in RSUD Dr. Saiful Anwar Malang from January 2018 – August 2023. Patients were assigned to TIMI flow grade <3 group (N =169) and TIMI flow grade 3 (N = 677) according to TIMI Flow degree after primary PCI. All the patient’s angiogram were evaluated for TIMI score and CHA2DS2-VASc score is based on a guideline. We concluded data in SPSS program and used the Spearman test and p value of .05 was considered as significant.

Result: From a total sample of 846 patients, the correlation between STE-ACS onset and TIMI flow indicates that a higher number of patients with STE-ACS onset <12 hours was found in the TIMI flow <3 and 3 groups (p=0.000). The cutoff CHA2DS2 VASC score's sensitivity and specificity values were ascertained using ROC analysis with cut off value 2.5. The incidence of decreased TIMI flow rate was more significant in the CHA2DS2-VASc ≥3 group with DM (+) and age ≥64 (OR value 0.156, p=0.000) than in the CHA2DS2-VASc ≥3 group without DM and age < 64. With an OR value of 2.94 (p=0.000), Killip class > 2 is another powerful predictor of lower TIMI flow.

Conclusion: The only variables in the CHA2DS2-VASc score component that are most strongly associated with the risk of reducing the degree of TIMI flow are DM, age, and Killip class.


acute coronary syndrome, percutaneous coronary intervention, CHA2DS2-VASc score, timi flow degree, slow flow- no reflow phenomena

Full Text:



Bonow RO, Mann DL, Zipes DP, Libby P. Braunwald’s Heart Disease e-Book: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences; 2011.

Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138(20):e618-e651.

Kolansky DM. Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden. American Journal of Managed Care. 2009;15(2):S36.

Cretu DE, Udroiu CA, Stoicescu CI, Tatu-Chitoiu G, Vinereanu D. Predictors of in-hospital mortality of ST-segment elevation myocardial infarction patients undergoing interventional treatment. An analysis of data from the RO-STEMI registry. Maedica (Bucur). 2015;10(4):295.

Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. Published online August 25, 2023. doi:10.1093/eurheartj/ehad191

Arnesen CAL, Veres K, Horváth-Puhó E, Hansen JB, Sørensen HT, Brækkan SK. Estimated lifetime risk of venous thromboembolism in men and women in a Danish nationwide cohort: impact of competing risk of death. Eur J Epidemiol. Published online 2022:1-9.

Gale CP, Manda SOM, Batin PD, Weston CF, Birkhead JS, Hall AS. Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database. Heart. 2008;94(11):1407-1412.

Kemenkes. Riskesdas.; 2018.

Huang X, Zheng W, Zhao XD, Nie SP. CHA2DS2-VASc score predicts the slow flow/no-reflow phenomenon in ST-segment elevation myocardial infarction patients with multivessel disease undergoing primary percutaneous coronary intervention. Medicine. 2021;100(21).

Henriques JPS, Zijlstra F, van ‘t Hof AWJ, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003;107(16):2115-2119.

Hanna EB. Practical Cardiovascular Medicine. John Wiley & Sons; 2022.

Gupta S, Gupta MM. No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction. Indian Heart J. 2016;68(4):539-551.

De Luca G, Parodi G, Sciagrà R, et al. Preprocedural TIMI flow and infarct size in STEMI undergoing primary angioplasty. J Thromb Thrombolysis. 2014;38:81-86.

Brown E. PCI in late-presenting STEMI: how late is too late? Published online 2022.

Bailleul C, Aissaoui N, Cayla G, et al. Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction: Results from the FAST-MI 2010 registry. Arch Cardiovasc Dis. 2018;111(2):101-108.

Bagaswoto HP, Maharani E, Setianto BY. Coronary Circulation and Hemodynamics. ACI (Acta Cardiologia Indonesiana). 2016;2(1).

Moroni F, Azzalini L, Caixeta A, Oliveira TP, Ybarra LF. TIMI flow and myocardial blushing after rescue PCI and cardiac magnetic resonance: Results from the Myocardial Salvage After Rescue Angioplasty: Evaluation by Magnetic Resonance (SAVE-ME) study. Int J Cardiol. 2022;369:77-79.

Mahfouz RA, Gad MM, Arab M. Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention. Pulse. 2021;9(3-4):125-132.

Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008;117(24):3152-3156.

Hurst JW, Walsh RA, Fuster V, Fang JC. Hurst’s the Heart Manual of Cardiology. McGraw-Hill; 2013.

Gallo G, Volpe M, Savoia C. Endothelial dysfunction in hypertension: current concepts and clinical implications. Front Med (Lausanne). 2022;8:798958.

Ciarambino T, Crispino P, Para O, Giordano M. Gender Medicine: A New Possible Frontiers of Venous Thromboembolism. Stresses. 2023;3(1):167-181.

Ashoori A, Pourhosseini H, Ghodsi S, et al. CHA2DS2-VASc score as an independent predictor of suboptimal reperfusion and short-term mortality after primary PCI in patients with acute ST segment elevation myocardial infarction. Medicina (B Aires). 2019;55(2):35.

Aparicio A, Cuevas J, Morís C, Martín M. Slow coronary blood flow: pathogenesis and clinical implications. European Cardiology Review. 2022;17.

Pechlivani N, Ajjan RA. Thrombosis and Vascular Inflammation in Diabetes: Mechanisms and Potential Therapeutic Targets. Front Cardiovasc Med. 2018;5. doi:10.3389/fcvm.2018.00001

Indolfi C, Torella D, Cavuto L, et al. Effects of balloon injury on neointimal hyperplasia in streptozotocin-induced diabetes and in hyperinsulinemic nondiabetic pancreatic islet-transplanted rats. Circulation. 2001;103(24):2980-2986. doi:10.1161/01.CIR.103.24.2980

Cury RC, Abbara S, Achenbach S, et al. CAD-RADSTM: Coronary Artery Disease – Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. Journal of the American College of Radiology. 2016;13(12):1458-1466.e9. doi:10.1016/j.jacr.2016.04.024

Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-1367. doi:10.1093/eurheartj/ehaa575

Overgaard CB, Sharma V, Hamid T, et al. Myocardial blush and microvascular reperfusion following manual thrombectomy during PCI for STEMI: insights from the TOTAL trial. Canadian Journal of Cardiology. 2015;31(10):S86-S87.

Seals DR, Jablonski KL, Donato AJ. Aging and vascular endothelial function in humans. Clin Sci. 2011;120(9):357-375.

Zhang J, Lenarczyk R, Marin F, et al. The interpretation of CHA2DS2-VASc score components in clinical practice: a joint survey by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, the EHRA Young Electrophysiologists, the association of cardiovascular nursing and allied professionals, and the European Society of Cardiology Council on Stroke. EP Europace. 2021;23(2):314-322.

Zhang QY, Ma SM, Sun JY. New CHA2DS2-VASc-HSF score predicts the no-reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. BMC Cardiovasc Disord. 2020;20(1):1-9.



  • There are currently no refbacks.

Copyright (c) 2024 Bayu Aji, Sasmojo Widito, Setyasih Anjarwani, Novi Kurnianingsih, Evit Ruspiono

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.