SPC365

The safety of early discharge for low-risk STEMI patients identified by Zwolle Risk Score

Session: SESSÃO DE POSTERS 32 - DOENÇAS CARDIOVASCULARES - EAM COM SUPRADESNIVELAMENTO DO SEGMENTO ST
Speaker: Marta Catarina Bernardo

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Marta Catarina Bernardo; Isabel Martins Moreira; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; Pedro Mateus; Sofia Silva Carvalho; José Ilídio Moreira; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="color:black">INTRODUCTION:</span></span></strong><span style="font-size:12.0pt"><span style="color:black"> Early discharge of patients (pts) with low-<span style="background-color:white">risk ST elevation myocardial infarction (STEMI) may be associated with better prognosis and increases efficiency of health care. The Zwolle&nbsp;Risk Score (ZRS) was designed to identify STEMI pts at risk of in hospital complications and has been validated for selection of pts for early discharge (Fig. 1). </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">AIM: </span></strong><span style="font-size:12.0pt">To identify the safety of early discharge (&lt;72h) in a population of pts with <span style="font-size:16px">low-risk STEMI</span> identified by Zwolle&nbsp;risk score. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">METHODS: </span></strong><span style="font-size:12.0pt">Retrospective study of low-risk STEMI pts enrolled in a multicentre registry from 2010-2024, identified by a Zwolle&nbsp;risk score &le;3 points. Pts were categorized into two groups: ED (early discharge group, &lt;72h) and LD (Late discharge group, &gt;72h). The primary endpoint was death/hospital readmission during 1 year of follow-up (FUP). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">RESULTS:</span></strong><span style="font-size:12.0pt"> A total of 5977 pts were included: 22,1% (1319) ED group, 77,9% (4658) LD group, mean age of 59,6 years, 80,1% males. LD pts were significantly older (57,7 (&plusmn;11,3) years vs 60,1 (&plusmn;12,1) years, p&lt;0,001), had higher prevalence of arterial hypertension (55,5% vs 49,9%, p&lt;0,001) and diabetes mellitus (21,7% vs 15,2%, p&lt;0,001) and less prevalence of past/active tobacco use (67,8% vs 58.6%, p&lt;0,001). LD pts had higher burden of comorbidities, namely chronic kidney disease (2,0% vs 1,1%, p= 0,03), neoplasia history (3,9% vs 2,7%, p= 0,04) and chronic obstructive pulmonary disease (2,5% vs 1,5%, p= 0,04). The median ZRS was 1 (IQR 0-2) for ED group and 2 (IQR 1-3) for LD group. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">During FUP, LD group had a significantly higher rate of the primary endpoint (14,8% vs 10,8%, log-rank p= 0,009). In the multivariate analysis, age (HR 1,01, 95% CI 1,0-1,1, p= 0,006), arterial hypertension (HR 1,3, 95% CI 1,0-1,7), diabetes mellitus (HR 14,4, 95% CI 2,0-104, neoplasia (HR 2,1, 95% CI 1,4-3,2) and dementia (HR 3,0, 95% CI 1,5-5,9) were associated with higher risk of the primary endpoint, whilst early discharge was not. In fact, early discharge remained associated with lower risk of primary endpoint (HR 0.74, 95% CI 0.58-0.98, p=0.042). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">CONCLUSION:</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"> In our cohort of low-risk STEMI patients identified by ZRS, early discharge was <span style="font-size:16px">a feasible and safe option, potentially reducing hospitalization costs without compromising long-term outcomes. However, even in this subgroup of low-</span>risk,<span style="font-size:14px"> </span><span style="font-size:16px">there was an&nbsp;</span></span></span></span><span style="font-size:16px"><span style="font-family:&quot;Calibri&quot;,sans-serif">association between worse prognosis and adverse baseline characteristics, </span><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">highlighting the need to integrate scores with clinical judgment.</span></span></span></p>