Predictive value of the Novel CHA2DS2-VASc-HSF-TT Score for No-reflow in Patients Undergoing Primary and Post-thrombolysis Percutaneous Coronary Intervention

Background: During primary PCI, coronary no-reflow occurs when microvascular obstruction persists despite open epicardial circulation. The CHA2DS2-VASc-HSF score, used to assess thromboembolic risk in atrial fibrillation, correlates also with no-reflow risk. This study aims to evaluate the novel CHA2DS2-VASc-HSF-TT score&#039;s predictive value for no-reflow in STEMI patients undergoing primary PCI. Methods: This study at Zagazig University Hospitals included 255 STEMI patients underwent PCI for STEMI from June 2024 till March 2025. The CHA2DS2-VASc-HSF-TT score was calculated, incorporating factors like thrombolysis usage and PCI delay and was correlated to no-reflow. In-hospital outcomes like mortality, heart failure and arrhythmias were assessed. Results: 22.35% of patients experienced no-reflow. Statistically significant associations with no-reflow included heart failure (P = 0.0159), diabetes (P = 0.0007), hypertension (P < 0.0001) and delayed PCI (>6 hours) (P < 0.0001). The CHA2DS2-VASc-HSF-TT score had an AUC of 0.846, with 82.5% sensitivity, 79.3% specificity, and 80% accuracy. PCI delay >6 hours was a strong predictor for no-reflow (AUC 0.955). Conclusion: The CHA2DS2-VASc-HSF-TT score is a strong predictor of no-reflow in STEMI patients (cutoff ≥5). Delayed PCI (>6 hours) is an important independent predictor, emphasizing the need for timely intervention or bridging thrombolysis to improve outcomes.