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Modified Zwolle Score with delta-Creatinine: enhanced safety of early discharge after STEMI
Session:
Painel 6 - Doença Coronária 7
Speaker:
Diogo Brás
Congress:
CPC 2020
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:
Posters
FP Number:
---
Authors:
Diogo Brás; Mafalda Carrington; Rita Caldeira Da Rocha; Antonio; Bruno Cordeiro Piçarra; José Eduardo Aguiar; RNSCA
Abstract
<p>INTRODUCTION </p> <p>The Zwolle score (ZS) is recommended to identify low-risk patients eligible for early discharge after acute ST-segment elevation myocardial infarction (STEMI), but as only one-third of STEMIs have a low ZS, the discharge is often postponed. Creatinine variation (Δ-Cr) also provide prognostic information after STEMI.</p> <p> </p> <p>PURPOSE</p> <p>The authors intend to test the "modified Zwolle Score" (MZS) model, which encompasses Δ-Cr as a variable that would enhance the discriminative power of the standard ZS, with the outcome of intra-hospital mortality or 30-day mortality (defined as early mortality).</p> <p> </p> <p>METHODS</p> <p>This is a retrospective study with data from a national multicentre registry. We have included 3.296 patients with STEMI. Zwolle score was calculated for each patient. It is defined by:</p> <p> </p> <p>-Killip 1: 0 points (p); Killip 2: 4p; Killip 3-4: 9p</p> <p>-TIMI 3 flow post: 0p; TIMI 2: 1p; TIMI 0-1: 2p</p> <p>-Age <60: 0p; ≥60: 2p</p> <p>-3-vessel disease: 1p</p> <p>-Anterior MI: 1p</p> <p>-Ischaemia time >4h: 1p</p> <p>Total 16 points.</p> <p> </p> <p>Δ-Cr was defined as maximum serum creatinine minus admission serum creatinine. A Δ-Cr≥0.3 was assigned 2 points in the Modified Zwolle Score, after interpretation of odds ratio via multivariate analysis.</p> <p>For prediction quality assessment, we have performed ROC curve analysis (with c-statistic and Youden Index) with both scoring systems versus the outcome early mortality.</p> <p> </p> <p>RESULTS</p> <p>The sample mean age is 63 ±14, and it is composed by 76.8% of males. The majority of patients presented Killip Class I (87.3%). The STEMI was anterior in 49.7% of patients and inferior in 49.8% of patients. The mean admission time was 5 days. Complications are described in table 1. Intrahospital mortality was 3% and 30-day mortality was 4% (cardiovascular and non-cardiovascular death).</p> <p>The mean ZS was 3.1 ±2.8 points, the mean MZS was 3 ±2.1 points and the mean Δ-Cr was 0.2 ±0.6mg/dL.</p> <p>The ROC curve analysis between ZS and early mortality revealed a c-statistic of 0.810 (CI 0.796-0.823), whereas the ROC curve between MZS and early mortality revealed a c-statistic of 0.853 (CI 0.841-0.865). The ROC curves comparison showed a statistically significant superiority of the MZS c-statistic, with a difference between AUC of 0.043 (p<.001, CI 95% .024-.063).</p> <p>The Youden index for MZS was ≥4.5p (optimal cut-off point: specificity 83%, sensitivity 78%, negative predicting value (NPV) 99%, positive predicting value 16% and accuracy 83%).</p> <p> </p> <p>CONCLUSION</p> <p>We conclude that by adding Δ-Cr to the standard ZS, a renal function parameter that was lacking in the ZS, its predicting capacity regarding early mortality in patients admitted with STEMI was increased.</p> <p>This is shown by its very high NPV at optimal cut-off point (99%), which make MZS a very good test to rule-out early mortality, which may lead to better distinction of patients who will benefit from early discharge.</p>
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