The correlation and clinical outcome between H2FPEF score and thrombus burden in STEMI patient

Background: Intracoronary thrombus burden (TB) in ST elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) increases the risk of adverse outcomes. The H2FPEF score, initially designed for heart failure with preserved ejection fraction (HFpEF), may help predict TB severity and clinical prognosis. Objectives: To investigate the interplay between H2FPEF score and TB in STEMI patients undergoing PCI and its impact on clinical outcomes, particularly major adverse cardiovascular events (MACE). Methods: In this prospective observational study conducted across two centers, a total of 100 consecutive patients presenting with STEMI who underwent primary PCI at Benha University Hospital and Mataria Teaching Hospital were enrolled. Based on angiographic assessment, participants were stratified into two groups: low TB (Grades 1–3) and high TB (Grades 4–5). Results: Hypertension (HTN) was substantially more prevalent in the high TB group (P = 0.011). The H2FPEF score was significantly higher in the high TB group (P = 0.03). MACE incidence was 25% in high TB patients vs. 7.5% in low TB patients (P = 0.026). ROC analysis identified an H2FPEF score >2 as a predictor of high TB (AUC = 0.694, P = 0.001) and MACE (AUC = 0.744, P = 0.004). Multivariate regression confirmed H2FPEF as an independent predictor of high TB (OR = 1.958, P = 0.006). Conclusions: The H2FPEF scoring system holds clinical utility in predicting both TB and MACE in patients with STEMI, with scores above 2 effectively delineating high-risk cases.