Creatinine variation improves Zwolle score in selecting low-risk patients after ST-segment elevation myocardial...

Area of Science:

• Cardiology
• Clinical Research
• Biomarkers

Background:

• The Zwolle score is recommended for identifying low-risk ST-segment elevation myocardial infarction (STEMI) patients eligible for early discharge.
• Early discharge strategies aim to optimize resource utilization and patient flow post-primary percutaneous coronary intervention (PCI).

Purpose of the Study:

• To evaluate if creatinine variation (Δ-sCr) can enhance the predictive performance of the Zwolle score.
• To determine if Δ-sCr improves the selection of STEMI patients suitable for early discharge after primary PCI.

Main Methods:

• A Modified-Zwolle score incorporating Δ-sCr was developed and compared to the original Zwolle score.
• 3296 STEMI patients undergoing primary PCI were analyzed from the Portuguese Registry on Acute Coronary Syndromes.
• The study assessed 30-day mortality, in-hospital mortality, and complications as primary and secondary endpoints.

Main Results:

• The Modified-Zwolle score demonstrated superior performance in predicting 30-day mortality (AUC 0.853 vs. 0.810), in-hospital mortality (AUC 0.889 vs. 0.845), and complications (AUC 0.728 vs. 0.719) compared to the original score.
• A net reclassification improvement of 6.8% was observed with the Modified-Zwolle score.
• Elevated Δ-sCr (≥0.3 mg/dl) was associated with significantly higher 30-day mortality, in-hospital mortality, and complications in both low and non-low-risk groups.

Conclusions:

• Δ-sCr significantly enhances the predictive accuracy of the Zwolle score for adverse outcomes in STEMI patients.
• The incorporation of Δ-sCr aids in refining the selection of patients who can safely undergo early discharge after primary PCI.
• This biomarker-enhanced approach supports clinical decision-making for optimizing post-STEMI care pathways.