Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty

Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty

Abstract Background The Zwolle risk score was designed to stratify the actual in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (p-PCI) but, also, for decision-making related to patients location in an intensive...

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Veröffentlicht in:European heart journal 2020-11, Vol.41 (Supplement_2)
Hauptverfasser: Cordero, A, Cid, B, Monteiro, P, Garcia-Acuna, J.M, Rodriguez-Manero, M, Trillo Noche, R, Lopez Otero, D, Sanmartin Pena, J.C, Bertomeu-Gonzalez, V, Escribano, D, Goncalvez, F, Goncalves, L, Zuazola, P, Gonzalez-Juanatey, J.R
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container_issue Supplement_2
container_start_page
container_title European heart journal
container_volume 41
creator Cordero, A
Cid, B
Monteiro, P
Garcia-Acuna, J.M
Rodriguez-Manero, M
Trillo Noche, R
Lopez Otero, D
Sanmartin Pena, J.C
Bertomeu-Gonzalez, V
Escribano, D
Goncalvez, F
Goncalves, L
Zuazola, P
Gonzalez-Juanatey, J.R
description Abstract Background The Zwolle risk score was designed to stratify the actual in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (p-PCI) but, also, for decision-making related to patients location in an intensive care unit or not. Since the GRACE score continues being the gold-standard for individual risk assessment in STEMI in most institutions we assessed the specificity of both scores for in-hospital mortality. Methods We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation as compared to the GRACE score in all patients admitted for STEMI in 3 tertitary hospitals. Patients with Zwolle risk score
doi_str_mv 10.1093/ehjci/ehaa946.1840
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Since the GRACE score continues being the gold-standard for individual risk assessment in STEMI in most institutions we assessed the specificity of both scores for in-hospital mortality. Methods We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation as compared to the GRACE score in all patients admitted for STEMI in 3 tertitary hospitals. Patients with Zwolle risk score <3 would qualify as “low risk”, 3–5 as “intermediate risk” and ≥6 as “high risk”. Patients with GRACE score <140 were classified as low-risk. Specificity, sensitivity and classification were assessed by ROC curves and the area under the curve (AUC). Results We included 4,446 patients, mean age 64.7 (13.6) years, 24% women and 39% with diabetes. Mean GRACE score was 157.3 (4.9) and Zwolle was 2.8 (3.3). In-hospital mortality was 10.6% (471 patients). Patients who died had higher GRACE score (218.4±4.9 vs. 149.6±37.5; p<0.001) and Zwolle score (7.6±4.3 vs. 2.3±2.18; p<0.001); a statistically significant increase of in-hospital mortality risk, adjusted adjusted by age, gender and revascularization, was observed with both scores (figure). A total of 1,629 patients (40.0%) were classified as low risk by the GRACE score and 2,962 (66.6%) by the Zwolle score; in-hospital mortality was 1.6% and 2.7%, respectively. Moreover, the was a significant increase of in-hospital mortality rate according to Zwolle categories (2.7%; 13.0%; 41.6%)The AUC of both score was the same (p=0.49) but the specificity of GRACE score <140 was 43.1% as compared to 72.6% obtained by Zwolle score <3; patients accurately classified was also lower with the GRACE score threshold (48.8% vs. 73.7%). Conclusions Selection of low-risk STEMI patients treated with p-PCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful for the care organization in clinical practice. Funding Acknowledgement Type of funding source: None]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/ehjci/ehaa946.1840</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>European heart journal, 2020-11, Vol.41 (Supplement_2)</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Cordero, A</creatorcontrib><creatorcontrib>Cid, B</creatorcontrib><creatorcontrib>Monteiro, P</creatorcontrib><creatorcontrib>Garcia-Acuna, J.M</creatorcontrib><creatorcontrib>Rodriguez-Manero, M</creatorcontrib><creatorcontrib>Trillo Noche, R</creatorcontrib><creatorcontrib>Lopez Otero, D</creatorcontrib><creatorcontrib>Sanmartin Pena, J.C</creatorcontrib><creatorcontrib>Bertomeu-Gonzalez, V</creatorcontrib><creatorcontrib>Escribano, D</creatorcontrib><creatorcontrib>Goncalvez, F</creatorcontrib><creatorcontrib>Goncalves, L</creatorcontrib><creatorcontrib>Zuazola, P</creatorcontrib><creatorcontrib>Gonzalez-Juanatey, J.R</creatorcontrib><title>Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty</title><title>European heart journal</title><description><![CDATA[Abstract Background The Zwolle risk score was designed to stratify the actual in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (p-PCI) but, also, for decision-making related to patients location in an intensive care unit or not. Since the GRACE score continues being the gold-standard for individual risk assessment in STEMI in most institutions we assessed the specificity of both scores for in-hospital mortality. Methods We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation as compared to the GRACE score in all patients admitted for STEMI in 3 tertitary hospitals. Patients with Zwolle risk score <3 would qualify as “low risk”, 3–5 as “intermediate risk” and ≥6 as “high risk”. Patients with GRACE score <140 were classified as low-risk. Specificity, sensitivity and classification were assessed by ROC curves and the area under the curve (AUC). Results We included 4,446 patients, mean age 64.7 (13.6) years, 24% women and 39% with diabetes. Mean GRACE score was 157.3 (4.9) and Zwolle was 2.8 (3.3). In-hospital mortality was 10.6% (471 patients). Patients who died had higher GRACE score (218.4±4.9 vs. 149.6±37.5; p<0.001) and Zwolle score (7.6±4.3 vs. 2.3±2.18; p<0.001); a statistically significant increase of in-hospital mortality risk, adjusted adjusted by age, gender and revascularization, was observed with both scores (figure). A total of 1,629 patients (40.0%) were classified as low risk by the GRACE score and 2,962 (66.6%) by the Zwolle score; in-hospital mortality was 1.6% and 2.7%, respectively. Moreover, the was a significant increase of in-hospital mortality rate according to Zwolle categories (2.7%; 13.0%; 41.6%)The AUC of both score was the same (p=0.49) but the specificity of GRACE score <140 was 43.1% as compared to 72.6% obtained by Zwolle score <3; patients accurately classified was also lower with the GRACE score threshold (48.8% vs. 73.7%). Conclusions Selection of low-risk STEMI patients treated with p-PCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful for the care organization in clinical practice. Funding Acknowledgement Type of funding source: None]]></description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqNkMFOAjEQhhujiYi-gKe-QLHddsv2aAgqCcaDaIyXzbg7lWKhm7ZKeHtXwbuXmcv_Tf75CLkUfCS4kVe4XDWunwBG6ZGoFD8iA1EWBTNalcdkwIUpmdbVyyk5S2nFOa-00AOyfgbvWsgubGiwNC-Rvm6D90hTEyJSGyJN6LH5S3xh3FEftiy69EEfF9P7Ge16Hjc50RwRMrZ06_KSdtGtoQ_D5t2FzkPKu3NyYsEnvDjsIXm6mS4md2z-cDubXM9ZI4qSs7EyRgjUpbZtqVH2XVuwspW8BTUGBKmsllKYMRZvsuKoeVFh278OYDlXckiK_d0mhpQi2vpQpha8_hFW_wqrD8LqH2E9xPZQ-Oz-k_8GCadxgw</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Cordero, A</creator><creator>Cid, B</creator><creator>Monteiro, P</creator><creator>Garcia-Acuna, J.M</creator><creator>Rodriguez-Manero, M</creator><creator>Trillo Noche, R</creator><creator>Lopez Otero, D</creator><creator>Sanmartin Pena, J.C</creator><creator>Bertomeu-Gonzalez, V</creator><creator>Escribano, D</creator><creator>Goncalvez, F</creator><creator>Goncalves, L</creator><creator>Zuazola, P</creator><creator>Gonzalez-Juanatey, J.R</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20201101</creationdate><title>Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty</title><author>Cordero, A ; Cid, B ; Monteiro, P ; Garcia-Acuna, J.M ; Rodriguez-Manero, M ; Trillo Noche, R ; Lopez Otero, D ; Sanmartin Pena, J.C ; Bertomeu-Gonzalez, V ; Escribano, D ; Goncalvez, F ; Goncalves, L ; Zuazola, P ; Gonzalez-Juanatey, J.R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1250-749911e656fd56e3086daf3d30da47aea34f633197e2b380e6028ed946aaf0043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cordero, A</creatorcontrib><creatorcontrib>Cid, B</creatorcontrib><creatorcontrib>Monteiro, P</creatorcontrib><creatorcontrib>Garcia-Acuna, J.M</creatorcontrib><creatorcontrib>Rodriguez-Manero, M</creatorcontrib><creatorcontrib>Trillo Noche, R</creatorcontrib><creatorcontrib>Lopez Otero, D</creatorcontrib><creatorcontrib>Sanmartin Pena, J.C</creatorcontrib><creatorcontrib>Bertomeu-Gonzalez, V</creatorcontrib><creatorcontrib>Escribano, D</creatorcontrib><creatorcontrib>Goncalvez, F</creatorcontrib><creatorcontrib>Goncalves, L</creatorcontrib><creatorcontrib>Zuazola, P</creatorcontrib><creatorcontrib>Gonzalez-Juanatey, J.R</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cordero, A</au><au>Cid, B</au><au>Monteiro, P</au><au>Garcia-Acuna, J.M</au><au>Rodriguez-Manero, M</au><au>Trillo Noche, R</au><au>Lopez Otero, D</au><au>Sanmartin Pena, J.C</au><au>Bertomeu-Gonzalez, V</au><au>Escribano, D</au><au>Goncalvez, F</au><au>Goncalves, L</au><au>Zuazola, P</au><au>Gonzalez-Juanatey, J.R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty</atitle><jtitle>European heart journal</jtitle><date>2020-11-01</date><risdate>2020</risdate><volume>41</volume><issue>Supplement_2</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract Background The Zwolle risk score was designed to stratify the actual in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (p-PCI) but, also, for decision-making related to patients location in an intensive care unit or not. Since the GRACE score continues being the gold-standard for individual risk assessment in STEMI in most institutions we assessed the specificity of both scores for in-hospital mortality. Methods We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation as compared to the GRACE score in all patients admitted for STEMI in 3 tertitary hospitals. Patients with Zwolle risk score <3 would qualify as “low risk”, 3–5 as “intermediate risk” and ≥6 as “high risk”. Patients with GRACE score <140 were classified as low-risk. Specificity, sensitivity and classification were assessed by ROC curves and the area under the curve (AUC). Results We included 4,446 patients, mean age 64.7 (13.6) years, 24% women and 39% with diabetes. Mean GRACE score was 157.3 (4.9) and Zwolle was 2.8 (3.3). In-hospital mortality was 10.6% (471 patients). Patients who died had higher GRACE score (218.4±4.9 vs. 149.6±37.5; p<0.001) and Zwolle score (7.6±4.3 vs. 2.3±2.18; p<0.001); a statistically significant increase of in-hospital mortality risk, adjusted adjusted by age, gender and revascularization, was observed with both scores (figure). A total of 1,629 patients (40.0%) were classified as low risk by the GRACE score and 2,962 (66.6%) by the Zwolle score; in-hospital mortality was 1.6% and 2.7%, respectively. Moreover, the was a significant increase of in-hospital mortality rate according to Zwolle categories (2.7%; 13.0%; 41.6%)The AUC of both score was the same (p=0.49) but the specificity of GRACE score <140 was 43.1% as compared to 72.6% obtained by Zwolle score <3; patients accurately classified was also lower with the GRACE score threshold (48.8% vs. 73.7%). Conclusions Selection of low-risk STEMI patients treated with p-PCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful for the care organization in clinical practice. Funding Acknowledgement Type of funding source: None]]></abstract><pub>Oxford University Press</pub><doi>10.1093/ehjci/ehaa946.1840</doi><oa>free_for_read</oa></addata></record>
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title Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty
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