System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 40247796 DOI: 10.2174/0115701611335913250408214530

Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry.

Curr Vasc Pharmacol

Authors: Giuseppe De Luca, Magdy Algowhary, Berat Uguz, Dinaldo C Oliveira, Vladimir Ganyukov, Zan Zimbakov, Miha Cercek, Lisette Okkels Jensen, Poay Huan Loh, Lucian Calmac, Gerard Roura I Ferrer, Alexandre Quadros, Marek Malewski, Fortunato Scotto Di Uccio, Clemens Von Birgelen, Francesco Versaci, Jurrien Ten Berg, Gianni Casella, Aaron Wong Sung Lung, Petr Kala, José Luis Díez Gil, Xavier Carillo, Maurits T Dirksen, Victor Manuel Becerra-Munoz, Michael Kang-Yin Lee, Dafsah Arifa Juzar, Rodrigo de Moura Joaquim, Roberto Paladino, Davor Miličić, Periklis Davlouros, Nikola Bakraceski, Filippo Zilio, Luca Donazzan, Adriaan Kraaijeveld, Gennaro Galasso, Lux Arpad, Lucia Marinucci, Vincenzo Guiducci, Maurizio Menichelli, Alessandra Scoccia, Aylin Hatice Yamac, Kadir Ugur Mert, Xacobe Flores Rios, Tomas Kovarnik, Michal Kidawa, Jose Moreu, Flavien Vincent, Enrico Fabris, Inigo Lozano Martínez-Luengas, Marco Boccalatte … and 42 other authors

Affiliations

  • AOU Policlinico G Martino, University of Messina Division of Cardiology Messina Italy.
  • Assiut University Heart Hospital, Assiut University Division of Cardiology Asyut Egypt.
  • Bursa City Hospital Division of Cardiology Bursa Türkiye.
  • Federal University of Pernambuco Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE Recife Brazil.
  • State Research Institute for Complex Issues of Cardiovascular Diseases Department of Heart and Vascular Surgery Kemerovo Russia.
  • Ss\' Cyril and Methodius University of Skopje University Clinic for Cardiology, Medical Faculty Skopje North Macedonia.
  • Ljubljana University Medical Centre Centre for Intensive Internal Medicine Ljubljana Slovenia.
  • Odense Universitets Hospital Division of Cardiology Odense Denmark.
  • National University Hospital Department of Cardiology Singapore Singapore.
  • Clinical Emergency Hospital of Bucharest Bucharest Romania.
  • Hospital Universitari de Bellvitge Interventional Cardiology Unit, Heart Disease Institute Barcelona Spain.
  • Instituto de Cardiologia do Rio Grande do Sul cardiology Porto Alegre Brazil.
  • Medical University of Silesia Division of Cardiology Katowice Poland.
  • Ospedale del Mare Division of Cardiology Napoli Italy.
  • Medisch Spectrum Twente, Thoraxcentrum Twente Department of Cardiology Enschede Netherlands.
  • Ospedale Santa Maria Goretti Division of Cardiology Latina Italy.
  • St. Antonius Hospital Division of Cardiology Nieuwegein Netherlands.
  • Ospedale Maggiore Division of Cardiology Bologna Italy.
  • National Heart Centre Singapore cardiology Singapore Singapore.
  • University Hospital Brno Medical Faculty of Masaryk University Brno Brno Czechia.
  • H. Universitario y Politécnico La Fe Valencia Spain.
  • Hospital Germans Triasi Pujol Badalona Spain.
  • Northwest Clinics Alkmaar cardiology Alkmaar Netherlands.
  • Hospital Clínico Universitario Virgen de la Victoria Málaga Spain.
  • Queen Elizabeth Hospital, University of Hong Kong cardiology Hong Kong China.
  • University of Indonesia National Cardiovascular Center "Harapan Kita" cardiology and Vascular Medicine Jakarta Indonesia.
  • Instituto de Cardiologia de Santa Catarina Praia Comprida cardiology São José Brazil.
  • Clinica Villa dei Fiori cardiology Acerra Italy.
  • University Hospital Centre, University of Zagreb Department of Cardiology Zagreb Croatia.
  • Patras University Hospital Invasive Cardiology and Congenital Heart Disease Patras Greece.
  • Center for Cardiovascular Diseases Ohrid North Macedonia.
  • Ospedale Santa Chiara di Trento Division of Cardiology Trento Italy.
  • Ospedale "S. Maurizio" Bolzano Division of Cardiology Bolzano Italy.
  • University Medical Center Utrecht Division of Cardiology Utrecht Netherlands.
  • Ospedali Riuniti San Giovanni di Dio e Ruggi d\'Aragona Division of Cardiology Salerno Italy.
  • Maastricht University Medical Centre Maastricht Netherlands.
  • Azienda Ospedaliera "Ospedali Riuniti Marche Nord" Division of Cardiology Pesaro Italy.
  • AUSL-IRCCS Reggio Emilia Division of Cardiology Reggio Emilia Italy.
  • Ospedale "F. Spaziani" Division of Cardiology Frosinone Italy.
  • Ospedale "Sant'Anna" Division of Cardiology Ferrara Italy.
  • Hospital Bezmialem Vakıf University İstanbul Department of Cardiology Istanbul Türkiye.
  • Eskişehir Osmangazi University Division of Cardiology, Faculty of Medicine Eskisehir Türkiye.
  • Complexo Hospetaliero Universitario La Coruna La Coruña Spain.
  • University Hospital Prague Prague Czechia.
  • Central Hospital of Medical University of Lodz Lodz Poland.
  • Complejo Hospitalario de Toledo Division of Cardiology Toledo Spain.
  • Center Hospitalier Universitaire de Lille Division of Cardiology Lille France.
  • Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste Trieste Italy.
  • Hospital de Cabueñes Division of Cardiology Gijón Spain.
  • Ospedale Santa Maria delle Grazie Division of Cardiology Pozzuoli Italy.

Abstract

BACKGROUND

Several scores have been developed to facilitate risk stratification and early discharge following primary angioplasty, particularly the Zwolle Risk Score (ZRS). However, validation in large-sized studies is still lacking. Therefore, the aim of the current study was to validate the use of the ZRS in a contemporary global population, including patients who were treated during the SARS-CoV-2 pandemic and enrolled in a large intercontinental observational study.

METHODS

The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia, and NorthAfrica, including patients treated from March 1st until June 30th, in 2019 and 2020]. ZRS was calculated for each patient. The patients were additionally categorized according to the following values of the ZRS [≤3; 4-6; 7-9; ≥10]. Our study outcomes were in-hospital and 30-day mortality. The discriminatory capacity of the ZRS was assessed by the area under the ROC curve [c statistic] as an index of model performance.

RESULTS

Our population is represented by 16084 STEMI patients undergoing mechanical reperfusion enrolled in 109 centers. The score showed a very good performance in the predicting mortality both in-hospital [AUC=0.83 [0.82-0.85], p<0.0001] and at 30- day follow-up [AUC=0.82 [0.81-0.84, p<0.0001]. The results were confirmed when the ZRS was separately applied to patients treated in 2019 and 2020, with good stability across time. ZRS was able to identify a large cohort [n=10672, 66.3%] of low-risk patients [score ≤3] with a very low mortality rate at 2 days [1%] and between 3 and 10 days [0.7%], with a very good negative predictive value for in-hospital [98.3%] and 30-day mortality [97.7%], with similar results in 2019 and 2020.

CONCLUSION

This study is the first to demonstrate the good prognostic performance of the ZRS in a large-scale contemporary global multicenter validation set. Similar results were obtained both in the pre-pandemic and the COVID-19 era. ZRS ≤3 identified a very low-risk population that could be discharged early, even during the COVID-19 pandemic, with expected advantages in the availability of hospital beds and nursing staff, costs of medical care, and in-hospital risk of contagion.

MeSH

Registries, Mortality, St Elevation Myocardial Infarction, Covid-19, Pandemics