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.
Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry / De Luca, Giuseppe; Algowhary, Magdy; Uguz, Berat; C Oliveira, Dinaldo; Ganyukov, Vladimir; Zimbakov, Zan; Cercek, Miha; Jensen, Lisette Okkels; Huan Loh, Poay; Calmac, Lucian; Roura I Ferrer, Gerard; Quadros, Alexandre; Malewski, Marek; Di Uccio, Fortunato Scotto; Von Birgelen, Clemens; Versaci, Francesco; Ten Berg, Jurrien; Casella, Gianni; Wong Sung Lung, Aaron; Kala, Petr; Díez Gil, José Luis; Carillo, Xavier; T Dirksen, Maurits; Manuel Becerra-Munoz, Victor; Kang-Yin Lee, Michael; Arifa Juzar, Dafsah; De Moura Joaquim, Rodrigo; Paladino, Roberto; Miličić, Davor; Davlouros, Periklis; Bakraceski, Nikola; Zilio, Filippo; Donazzan, Luca; Kraaijeveld, Adriaan; Galasso, Gennaro; Arpad, Lux; Marinucci, Lucia; Guiducci, Vincenzo; Menichelli, Maurizio; Scoccia, Alessandra; Hatice Yamac, Aylin; Ugur Mert, Kadir; Flores Rios, Xacobe; Kovarnik, Tomas; Kidawa, Michal; Moreu, Jose; Vincent, Flavien; Fabris, Enrico; Lozano Martínez-Luengas, Inigo; Boccalatte, Marco; Bosa Ojeda, Francisco; Arellano-Serrano, Carlos; Caiazzo, Gianluca; Cirrincione, Giuseppe; Kao, Hsien-Li; Sanchis Fores, Juan; Vignali, Luigi; Pereira, Hélder; Manzo-Silbermann, Stephane; Ordonez, Santiago; Arat Ozkan, Alev; Scheller, Bruno; Lehtola, Heidi; Teles, Rui; Mantis, Christos; Antti, Ylitalo; Brum Silveira, Joao Antonio; Zoni, Rodrigo; Bessonov, Ivan; Savonitto, Stefano; Kochiadakis, George; Alexopulos, Dimitrios; E Uribe, Carlos; Kanakakis, John; Faurie, Benjamin; Gabrielli, Gabriele; Gutierrez Barrios, Alexandro; Bachini, Jaun Pablo; Rocha, Alex; Chor-Cheung Tam, Frankie; Rodriguez, Alfredo; Lukito, Antonia Anna; Saint Joy, Veauthyelau; Pessah, Gustavo; Cortese, Giuliana; Parodi, Guido; Burgadha, Mohammed Abed; Kedhi, Elvin; Lamelas, Pablo; Suryapranata, Harry; Nardin, Matteo; Verdoia, Monica. - In: CURRENT VASCULAR PHARMACOLOGY. - ISSN 1570-1611. - 23:(2025), pp. "-"-"-". [Epub ahead of print] [10.2174/0115701611335913250408214530]
Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry
Fabris, Enrico;
2025-01-01
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.Pubblicazioni consigliate
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