Cardiology Department, Hospital do Espírito Santo, Évora.
General Surgery Department, Hospital Professor Doutor Fernando Fonseca, Amadora.
Coron Artery Dis. 2021 Sep 1;32(6):489-499. doi: 10.1097/MCA.0000000000001002.
The Zwolle score is recommended to identify ST-segment elevation myocardial infarction (STEMI) patients with low-risk eligible for early discharge. Our aim was to ascertain if creatinine variation (Δ-sCr) would improve Zwolle score in the decision-making of early discharge after primary percutaneous coronary intervention (PCI).
A total of 3296 patients with STEMI that underwent primary PCI were gathered from the Portuguese Registry on Acute Coronary Syndromes. A Modified-Zwolle score, including Δ-sCr, was created and compared with the original Zwolle score. Δ-sCr was also compared between low (Zwolle score ≤3) and non-low-risk patients (Zwolle score >3). The primary endpoint is 30-day mortality and the secondary endpoints are in-hospital mortality and complications. Thirty-day mortality was 1.5% in low-risk patients (35 patients) and 9.2% in non-low-risk patients (92 patients). The Modified-Zwolle score had a better performance than the original Zwolle score in all endpoints: 30-day mortality (area under curve 0.853 versus 0.810, P < 0.001), in-hospital mortality (0.889 versus 0.845, P < 0.001) and complications (0.728 versus 0.719, P = 0.037). Reclassification of patients lead to a net reclassification improvement of 6.8%. Additionally, both original Zwolle score low-risk patients and non-low-risk patients who had a Δ-sCr ≥0.3 mg/dl had higher 30-day mortality (low-risk: 1% versus 6.6%, P < 0.001; non-low-risk 4.4% versus 20.7%, P < 0.001), in-hospital mortality and complications.
Δ-sCr enhanced the performance of Zwolle score and was associated with higher 30-day mortality, in-hospital mortality and complications in low and non-low-risk patients. This data may assist the selection of low-risk patients who will safely benefit from early discharge after STEMI.
Zwolle 评分用于识别适合早期出院的低危 ST 段抬高型心肌梗死（STEMI）患者。我们的目的是确定肌酸酐变化（Δ-sCr）是否会改善原发性经皮冠状动脉介入治疗（PCI）后早期出院决策中的 Zwolle 评分。
从葡萄牙急性冠状动脉综合征注册中心收集了 3296 例接受原发性 PCI 的 STEMI 患者。创建了包含 Δ-sCr 的改良 Zwolle 评分，并与原始 Zwolle 评分进行比较。还比较了低危（Zwolle 评分≤3）和非低危患者（Zwolle 评分>3）之间的 Δ-sCr。主要终点为 30 天死亡率，次要终点为院内死亡率和并发症。低危患者（35 例）的 30 天死亡率为 1.5%，非低危患者（92 例）的死亡率为 9.2%。改良 Zwolle 评分在所有终点的表现均优于原始 Zwolle 评分：30 天死亡率（曲线下面积 0.853 与 0.810，P<0.001），院内死亡率（0.889 与 0.845，P<0.001）和并发症（0.728 与 0.719，P=0.037）。对患者的重新分类导致净重新分类改善 6.8%。此外，原始 Zwolle 评分低危患者和 Δ-sCr≥0.3mg/dl 的非低危患者的 30 天死亡率更高（低危：1%与 6.6%，P<0.001；非低危：4.4%与 20.7%，P<0.001），院内死亡率和并发症。
Δ-sCr 提高了 Zwolle 评分的性能，并与低危和非低危患者的 30 天死亡率、院内死亡率和并发症相关。这些数据可能有助于选择低危患者，他们将从 STEMI 后安全的早期出院中受益。
