The Zwolle risk score successfully identified low-risk STEMI patients, with those scoring ≤3 having 0% 30-day mortality compared to 12.4% in higher-risk patients (p<0.001).
Cohort (n=276)
Does the Zwolle risk score accurately identify low-risk STEMI patients treated with PPCI who can be safely discharged early?
The Zwolle risk score is a highly discriminative tool that can safely identify STEMI patients treated with PPCI for early discharge within 72 hours.
Absolute Event Rate: 0% vs 12.4%
p-value: p=<0.001
INTRODUCTION AND AIM: The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population. METHODS: We studied 276 consecutive patients (mean age 62 ± 14 years, 75% male, 20% Killip class >1) admitted over a two-year period for STEMI and treated with PPCI. ZRS, length of stay, 30-day mortality and readmission were obtained for all patients. Low risk was defined as ZRS ≤ 3. RESULTS: The median ZRS was 3 (interquartile range IQR 1-4), with 171 patients (62%) being classified as low risk. Thirty-day mortality was 4.7% (13 patients). Compared to other patients, low-risk patients had shorter length of stay (median 5.0 IQR 4-7 vs. 7.0 5-13 days, p<0.001), and lower 30-day mortality (0 vs. 12.4%, p<0.001), yielding a negative predictive value of 100% (95% CI 97.0-100%) for the proposed cutoff. The ZRS showed excellent discriminative power (C-statistic: 0.937, 95% CI 0.906-0.968, p<0.001), and good calibration against the original cohort. CONCLUSIONS: The ZRS appears to perform well in identifying low-risk STEMI patients who could be safely discharged within 72 hours of admission. Using the ZRS in our population could result in a more rational use of in-patient resources.
Tralhão et al. (Tue,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=276). Zwolle risk score (ZRS) ≤ 3 vs. ZRS > 3 was evaluated on 30-day mortality (p=<0.001). The Zwolle risk score successfully identified low-risk STEMI patients, with those scoring ≤3 having 0% 30-day mortality compared to 12.4% in higher-risk patients (p<0.001).