Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Abstract

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.

Keywords: Alta precoce; Early discharge; Enfarte agudo do miocárdio com supradesnivelamento de ST; Intervenção coronária percutânea primária; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction; Score de Zwolle; Zwolle risk score.