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

Autores de IIS La Fe

• José Luis Díez Gil

  Autor

Participantes ajenos a IIS La Fe

• De Luca G
• Algowhary M
• Uguz B
• C Oliveira D
• Ganyukov V
• Zimbakov Z
• Cercek M
• Jensen LO
• Huan Loh P
• Calmac L
• Roura I Ferrer G
• Quadros A
• Malewski M
• Di Uccio FS
• Von Birgelen C
• Versaci F
• Ten Berg J
• Casella G
• Wong Sung Lung A
• Kala P
• Carillo X
• T Dirksen M
• Manuel Becerra-Munoz V
• Kang-Yin Lee M
• Arifa Juzar D
• de Moura Joaquim R
• Paladino R
• Milicic D
• Davlouros P
• Bakraceski N
• Zilio F
• Donazzan L
• Kraaijeveld A
• Galasso G
• Arpad L
• Marinucci L
• Guiducci V
• Menichelli M
• Scoccia A
• Hatice Yamac A
• Ugur Mert K
• Flores Rios X
• Kovarnik T
• Kidawa M
• Moreu J
• Vincent F
• Fabris E
• Lozano Martínez-Luengas I
• Boccalatte M
• Bosa Ojeda F
• Arellano-Serrano C
• Caiazzo G
• Cirrincione G
• Kao HL
• Sanchis Fores J
• Vignali L
• Pereira H
• Manzo-Silbermann S
• Ordonez S
• Arat Ozkan A
• Scheller B
• Lehtola H
• Teles R
• Mantis C
• Antti Y
• Brum Silveira JA
• Zoni R
• Bessonov I
• Savonitto S
• Kochiadakis G
• Alexopulos D
• E Uribe C
• Kanakakis J
• Faurie B
• Gabrielli G
• Gutierrez Barrios A
• Bachini JP
• Rocha A
• Chor-Cheung Tam F
• Rodriguez A
• Lukito AA
• Saint Joy V
• Pessah G
• Cortese G
• Parodi G
• Burgadha MA
• Kedhi E
• Lamelas P
• Suryapranata H
• Nardin M
• Verdoia M

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

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.

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Keywords

• COVID-19 registry; STEMI patients; Zwolle Risk Score; mechanical reperfusion; pandemic.