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

Journal of the American Heart AssociationParr CJ, Avery L, Hiebert B, et al. | February 10, 2022


For identification of the risk of complications in patients with ST‐segment‒elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI), development of the Zwolle Risk Score was done. Researchers herein evaluated its utility to triage patients with STEMI following PCI, including patients receiving thrombolysis.

  • Researchers included patients aged ≥ 18 years with STEMI and primary PCI or PCI after thrombolysis.

  • In the developed triage protocol, high‐risk patients (those with Zwolle Risk Score ≥ 4) were triaged to the cardiac intensive care unit.

  • The triaging protocol was prospectively evaluated on 452 patients, mean age 65 ± 12 years, 73% men.

  • Thrombolysis was performed in 72 patients (16%).

  • Low‐ and high‐risk patients had in‐hospital mortality of 0% vs 9%, respectively.

  • Higher rates of cardiogenic shock (34% vs 1%), pulmonary edema (60% vs 9%), arrhythmia (25% vs 2%), blood transfusion (10% vs 2%), and stroke (4% vs 0.4%) were observed among high‐risk patients.

  • There was a reduction in median hospital costs by $1,419 per low‐risk patient after protocol implementation.

  • Overall findings suggest a Zwolle‐based triaging system as safe and valuable for lowering cardiac intensive care unit usage costs for patients with STEMI following primary PCI or PCI following thrombolysis.

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