Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences Max Rady College of Medicine, University of Manitoba Winnipeg MB Canada.
Cardiac Sciences Manitoba St. Boniface Hospital Winnipeg MB Canada.
J Am Heart Assoc. 2022 Feb 15;11(4):e024759. doi: 10.1161/JAHA.121.024759. Epub 2022 Feb 8.
Background The Zwolle Risk Score was designed to identify the risk of complications in patients with ST-segment‒elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI). Its utility following PCI in STEMI treated with thrombolysis is unknown. The objective was to evaluate the safety of using the Zwolle Risk Score to triage patients with STEMI following PCI, including patients receiving thrombolysis. Methods and Results Patients aged ≥18 years with STEMI and primary PCI or PCI after thrombolysis were included. A triage protocol was developed, with high-risk patients those with Zwolle Risk Score ≥4 triaged to the cardiac intensive care unit. A prospective evaluation of the triaging protocol was performed on 452 patients, mean age 65±12 years, 73% men. Median Zwolle Risk Score was 3 (interquartile range, 2‒5), with 257 low-risk (57%), and 195 high-risk (43%) patients. Adherence to the protocol was 91%. In-hospital mortality was 0.4% in low-risk and 13% in high-risk patients (<0.001). Seventy-two patients (16%) received thrombolysis. Median time post-thrombolysis to PCI was 281 minutes (interquartile range, 219‒376). In-hospital mortality was 0% versus 9% (=0.083) for low- and high-risk patients, respectively. High-risk patients had higher rates of cardiogenic shock (34% versus 1%, <0.001), pulmonary edema (60% versus 9%, <0.001), arrhythmia (25% versus 2%, <0.001), blood transfusion (10% versus 2%, <0.001), and stroke (4% versus 0.4%, =0.011). Median hospital costs decreased by $1419 per low-risk patient after protocol implementation. Conclusions For patients with STEMI following primary PCI or PCI following thrombolysis, a Zwolle-based triaging system is safe and may decrease cardiac intensive care unit usage costs.
背景 Zwolle 风险评分旨在识别接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者发生并发症的风险。其在接受溶栓治疗的 STEMI 患者 PCI 后的应用效果尚不清楚。本研究旨在评估使用 Zwolle 风险评分对接受 PCI 治疗的 STEMI 患者（包括接受溶栓治疗的患者）进行分诊的安全性。
方法和结果 入选年龄≥18 岁的 STEMI 患者，行直接 PCI 或溶栓后 PCI。制定了分诊方案，Zwolle 风险评分≥4 分的高危患者分诊至心脏重症监护病房。对 452 例患者前瞻性评估分诊方案，患者平均年龄 65±12 岁，73%为男性。中位 Zwolle 风险评分为 3 分（四分位距 2‒5 分），低危患者 257 例（57%），高危患者 195 例（43%）。方案的执行率为 91%。低危患者住院死亡率为 0.4%，高危患者为 13%（<0.001）。72 例（16%）患者接受溶栓治疗。溶栓后至 PCI 的中位时间为 281 分钟（四分位距 219‒376 分钟）。低危和高危患者的住院死亡率分别为 0%和 9%（=0.083）。高危患者心源性休克（34%比 1%，<0.001）、肺水肿（60%比 9%，<0.001）、心律失常（25%比 2%，<0.001）、输血（10%比 2%，<0.001）和卒中（4%比 0.4%，=0.011）发生率更高。方案实施后，每例低危患者的住院费用降低 1419 美元。
结论 对于直接 PCI 或溶栓后 PCI 的 STEMI 患者，基于 Zwolle 评分的分诊系统安全有效，可能降低心脏重症监护病房的使用成本。
