Zwolle Risk Score as a Predictor of In-Hospital Mortality in Post Primary Percutaneous Coronary Intervention St-Elevation Myocardial Infarction Patients

Sana Afnanzai Zai; Ali Nawaz  Khan; Ayaz    Ahmad; Ali   Abbas; Ulfat  Ara; Nighat  Noor

doi:10.51253/pafmj.v76iSUPPL-8.14254

Authors

Sana Afnanzai Zai Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan https://orcid.org/0009-0003-3242-5994
Ali Nawaz Khan Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ayaz Ahmad Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ali Abbas Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ulfat Ara Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Nighat Noor Department of Adult Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-8.14254

Keywords:

In-hospital Mortality, Percutaneous coronary intervention, ST-elevation myocardial infarction, Zwolle Risk Score

Abstract

Objective: To determine the Zwolle Risk Score's (ZRS) prediction accuracy during coronary angiography for clinical outcome in post PCI patients with ST-elevation myocardial infarction keeping in-hospital mortality as primary endpoint.

Study Design: Analytical Cross sectional study.

Place and Duration of Study: Adult Cardiology, Armed Forces Institute of Cardiology (AFIC/NNIHD) Rawalpindi, Pakistan from May to Nov 2025.

Methodology: Four hundred six STEMI patients of both sexes were enrolled, with age between 18 to 80 years using the non-probability consecutive sampling technique. Patients with NSTEMI, unstable angina, history of PCI or CABG, patients with incomplete clinical data were excluded. ZRS was calculated before the coronary angiography and a score >6 categorized as positive predictor of in-hospital mortality. Every patient was followed up by 72 hours to record mortality outcomes. The parameters of the diagnostic accuracy were determined.

Results: out of Four hundred six patients 311(76.6%) participants were men. Mean age was 38.75±13.07 years. We analyzed that 95(23.4%) patients were categorized as high risk on the basis of ZRS score while actual in-hospital mortality was counted as 43(10.6%). The study's sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were 81.4%, 83.5%, 36.8%, 97.4%, and 83.3%, respectively.

Conclusion: The ZRS has a satisfactory diagnostic accuracy in predicting early in-hospital mortality in patients with STEMI who underwent PPCI, with a high sensitivity and negative predictive value. Its ability to repeatedly rule out the risk of early death makes it a practical tool in first-line triage and overall risk selection ..

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References

1. Elendu C, Amaechi DC, Elendu TC, Omeludike EK, Alakwe-Ojimba CE, Obidigbo B, et al. Comprehensive review of ST-segment elevation myocardial infarction: Understanding pathophysiology, diagnostic strategies, and current treatment approaches. Medicine 2023; 102(43): e35687.

https://doi.org/10.1097/MD.0000000000035687

2. Samad Z, Hanif B. Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future. Circulation 2023; 147(17): 1261-1263.

https://doi.org/10.1161/Circulationaha.122.059122

3. Nishtar SS. STEMI Pakistan; A National Heart Attack Management Program. Pak J Cardiovasc Interv 2022; 2(2): 17-23.

https://doi.org/10.58889/PJCVI.3.17.23

4. Scholz KH, Meyer T, Lengenfelder B, Vahlhaus C, Tongers J, Schnupp S, et al. Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction. Open Heart 2021; 8(1): e001650. https://doi.org/10.1136/openhrt-2021-001650

5. Cosentino N, Bartorelli AL, Marenzi G. Time to treatment still matters in ST-elevation myocardial infarction: a call to maintain treatment effectiveness during the COVID-19 pandemic. Eur Heart J Cardiovasc Pharmacother 2020; 6(6): 408-409.

https://doi.org/10.1093/ehjcvp/pvaa054

6. Parr CJ, Avery L, Hiebert B, Liu S, Minhas K, Ducas J. Using the Zwolle Risk Score at Time of Coronary Angiography to Triage Patients With ST-Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention or Thrombolysis. J Am Heart Assoc 2022; 11(4): e024759.

https://doi.org/10.1161/JAHA.121.024759

7. Tralhão A, Ferreira AM, Madeira S, Borges Santos M, Castro M, Rosário I, et al. Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Rev Port Cardiol 2015; 34(9): 535-541.

https://doi.org/10.1016/j.repc.2015.04.006

8. Banga S, Gumm DC, Kizhakekuttu TJ, Emani VK, Singh S, Singh S, et al. Left Ventricular Ejection Fraction along with Zwolle Risk Score for Risk Stratification to Enhance Safe and Early Discharge in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Retrospective Observational Study. Cureus 2019; 11(7): e5272. https://doi.org/10.7759/cureus.5272

9. Hwang C. ECG Diagnosis: ST-Elevation Myocardial Infarction. Perm J 2014; 18: e133-134.

https://doi.org/10.7812/TPP/13-127

10. Wang C, Wang H, Wu K, Cheng F, Cheng C, Kung C, et al. Comparison of Different Risk Scores for Prediction of In-Hospital Mortality in STEMI Patients Treated with PPCI. Emerg Med Int 2022; 2022: 1-7.

https://doi.org/10.1155/2022/1022078

11. Cordero A, Cid-Alvarez B, Monteiro P, García-Acuña JM, Gonçalves F, Escribano D, et al. Applicability of the Zwolle score for selection of very high-risk ST-elevation myocardial infarction patients treated with primary angioplasty. Angiology 2022; 75(2): 175-181. https://doi.org/10.1177/00033197221139915

12. Assiri AS. Gender differences in clinical presentation and management of patients with acute coronary syndrome in Southwest of Saudi Arabia. J Saudi Heart Assoc 2011; 23(3): 135-141. https://doi.org/10.1016/j.jsha.2011.01.007

13. Liang MT, Pang Y, Gao LL, Han LJ, Yao HC. Clinical risk factors and outcomes of young patients with acute ST segment elevation myocardial infarction: a retrospective study. BMC Cardiovasc Disord 2023; 23(1): 353.

https://doi.org/10.1186/s12872-023-03392-8

14. Sood A, Singh A, Gadkari C. Myocardial Infarction in Young Individuals: A Review Article. Cureus 2023; 15(4): e37102.

https://doi.org/10.7759/cureus.37102

15. Yousif N, Chachar TS, Subbramaniyam S, Vadgaonkar V, Noor HA. Safety and feasibility of 48 h discharge after successful primary percutaneous coronary intervention. J Saudi Heart Assoc 2021; 33(1): 1-4. https://doi.org/10.37616/2212-5043.1242

16. Asrial A, Pudjiastuti A, Herry Y, Bahrudin U. Validation and Comparison of Zwolle, TIMI, and GRACE Risk Scores for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention in The Indonesian Population. IJC 2022; 43(2): 56-63. https://doi.org/10.30701/ijc.1324

17. Ali Shah J, Ahmed Solangi B, Batra MK, Khan KA, Shah GA, Ali G, at al. Zwolle Risk Score for Safety Assessment of Same-day Discharge after Primary Percutaneous Coronary Intervention. J Saudi Heart Assoc 2021; 33(4): 332-338.

https://doi.org/10.37616/2212-5043.1283

18. Lim TW, Karim TS, Fernando M, Haydar J, Lightowler R, Yip B, et al. Utility of Zwolle Risk Score in Guiding Low-Risk STEMI Discharge. Heart Lung Circ 2021; 30(4): 489-495.

https://doi.org/10.1016/j.hlc.2020.08.026