Key result
In STEMI patients undergoing primary PCI, an LVEF <50% was associated with a significantly longer hospital length of stay (RR 1.40) and ICU stay, and adding LVEF to the Zwolle risk score improved risk stratification.
Why the study?
The authors investigated whether adding LVEF to the Zwolle risk score improves decision-making for safe and early discharge in STEMI patients after primary PCI.
Does adding LVEF to the Zwolle risk score improve risk stratification for early and safe discharge in STEMI patients undergoing primary PCI?
Observational (n=249)
No
Does adding LVEF to the Zwolle risk score improve risk stratification for early and safe discharge in STEMI patients undergoing primary PCI?
Adding LVEF to the Zwolle Risk Score improves risk stratification for STEMI patients post-primary PCI, providing a better model to identify candidates for safe and early discharge.
LVEF <50% may aid identification of STEMI patients needing longer stays; supports adding LVEF to Zwolle score but leaves open prospective validation before practice change.
Introduction Zwolle risk score (ZRS) is a validated scoring system to determine the time of discharge in ST-segment elevation myocardial infarction (STEMI) patients. Left ventricular ejection fraction (LVEF) also provides prognostic information after ST-elevation myocardial infarction (STEMI). We studied that the addition of LVEF to ZRS variable can improve decision making in safe and early discharge in STEMI patients post-primary coronary intervention. Methods Overall, 249 STEMI patients were studied retrospectively. LVEF was considered as an independent variable. The patients having LVEF <50% were under Group A and LVEF ≥50% were under Group B. Groups were analyzed by model comparison for overall hospital length of stay (LOS) and Intensive care unit (ICU) LOS post-primary percutaneous coronary intervention (PCI). Results There were 123 patients in Group A and 126 patients in Group B. Comparison for primary outcomes showed significant difference with hospital length of stay (LOS) being 3.1 ± 2.3 days in Group A versus 2.1 ± 0.8 days in Group B (p < 0.001). Similarly, ICU stay was also significantly higher in Group A with 36.5 ± 31.4 hours versus 24.0 ± 11.8 hours for Group B, which led to prolonged hospitalization for patients with LVEF <50%. Model 1 that considers ZRS individually is nested within Model 2 where ZRS and LVEF are considered together. The profile log-likelihood ratio test favors model 2 over model 1 (p < 0.0001). Similarly for ICU LOS, R2 = 0.12 (Model 1) < R2 = 0.20 (Model 2). The F test favors model 2 over model 1 (p < 0.0001). Conclusion We concluded that adding LVEF to Zwolle risk score gives a better model for risk stratification in STEMI patients to decide early and safe discharge post-primary PCI.
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Banga et al. (2019) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=249). Left ventricular ejection fraction (LVEF) <50% vs. LVEF ≥50% was evaluated on Hospital length of stay (days) (RR 1.40, 95% CI 1.19-1.65, p=<0.0001). In STEMI patients undergoing primary PCI, an LVEF <50% was associated with a significantly longer hospital length of stay (RR 1.40) and ICU stay, and adding LVEF to the Zwolle risk score improved risk stratification.
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