Key result
The Zwolle risk score (≥4) demonstrated higher specificity than the GRACE score for identifying high-risk STEMI patients treated with primary percutaneous coronary intervention.
Why the study?
The Zwolle risk score was designed to stratify in-hospital mortality risk in STEMI patients treated with primary PCI and guide admission unit decisions, but its accuracy compared with the GRACE score needed assessment.
Does the Zwolle risk score improve the accuracy of high-risk categorization for in-hospital mortality compared to the GRACE score in STEMI patients treated with primary PCI?
Observational (n=4,446)
Yes
Does the Zwolle risk score improve the accuracy of high-risk categorization for in-hospital mortality compared to the GRACE score in STEMI patients treated with primary PCI?
The Zwolle risk score offers higher specificity than the GRACE score for identifying high-risk STEMI patients undergoing primary PCI, which may aid in clinical decision-making and unit admission.
May refine high-risk STEMI triage post-PCI; leaves open prospective validation before practice change.
The Zwolle risk score was designed to stratify in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) and for decision-making in the unit where patients are admitted. We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation compared with the GRACE score in all patients (n = 4446) admitted for STEMI in 3 university hospitals. Only one fourth of the patients were classified as high-risk by the Zwolle risk score vs 60% by the GRACE score. In-hospital mortality was 10.6%. A statistically significant increase in in-hospital mortality, adjusted by age, gender, and revascularization, was observed with both scores. The assessment of the optimal cut-off points verified the accuracy of Zwolle score ≥4 as optimal threshold for high-risk categorization. In contrast, GRACE score ≥140 had very low specificity as well as percentage of patients correctly classified; GRACE score ≥175 was fairly better. The reclassification index of the Zwolle score after applying the GRACE score was 35.5%. Selection of high-risk STEMI patients treated with pPCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful in clinical practice.
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Cordero et al. (2022) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=4,446). Zwolle risk score vs. GRACE score was evaluated on In-hospital mortality estimation accuracy. The Zwolle risk score (≥4) demonstrated higher specificity than the GRACE score for identifying high-risk STEMI patients treated with primary percutaneous coronary intervention.
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