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Wang J, Shen B, Feng X, Zhang Z, Liu J, Wang Y. A Review of Prognosis Model Associated With Cardiogenic Shock After Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:754303. [PMID: 34957245 PMCID: PMC8702644 DOI: 10.3389/fcvm.2021.754303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Cardiogenic shock seriously affects the survival rate of patients. However, few prognostic models are concerned with the score of cardiogenic shock, and few clinical studies have validated it. In order to optimize the diagnosis and treatment of myocardial infarction complicated with cardiogenic shock and facilitate the classification of clinical trials, the prognosis score model is urgently needed. Methods: Cardiogenic shock, severe case, prognosis score, myocardial infarction and external verification were used as the search terms to search PubMed, Embase, Web of Science, Cochrane, EBSCO (Medline), Scopus, BMC, NCBI, Oxford Academy, Science Direct, and other databases for pertinent studies published up until 1 August 2021. There are no restrictions on publication status and start date. Filter headlines and abstracts to find articles that may be relevant. The list of references for major studies was reviewed to obtain more references. Results and Conclusions: The existing related models are in urgent need of more external clinical verifications. In the meanwhile, with the development of molecular omics and the clinical need for optimal treatment of CS, it is urgent to establish a prognosis model with higher differentiation and coincidence rates.
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Affiliation(s)
| | | | | | | | | | - Yushi Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
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2
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Rodrigues Brás D, Gomes A, Semedo P, Santos AR, Cordeiro Piçarra B, Carrington M, Pais J, Rocha AR, Congo K, Neves D, Bento Â, Fernandes R, Trinca M, Patrício L. Creatinine variation improves Zwolle score in selecting low-risk patients after ST-segment elevation myocardial infarction. Coron Artery Dis 2021; 32:489-499. [PMID: 33394698 DOI: 10.1097/mca.0000000000001002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Zwolle score is recommended to identify ST-segment elevation myocardial infarction (STEMI) patients with low-risk eligible for early discharge. Our aim was to ascertain if creatinine variation (Δ-sCr) would improve Zwolle score in the decision-making of early discharge after primary percutaneous coronary intervention (PCI). METHODS AND RESULTS A total of 3296 patients with STEMI that underwent primary PCI were gathered from the Portuguese Registry on Acute Coronary Syndromes. A Modified-Zwolle score, including Δ-sCr, was created and compared with the original Zwolle score. Δ-sCr was also compared between low (Zwolle score ≤3) and non-low-risk patients (Zwolle score >3). The primary endpoint is 30-day mortality and the secondary endpoints are in-hospital mortality and complications. Thirty-day mortality was 1.5% in low-risk patients (35 patients) and 9.2% in non-low-risk patients (92 patients). The Modified-Zwolle score had a better performance than the original Zwolle score in all endpoints: 30-day mortality (area under curve 0.853 versus 0.810, P < 0.001), in-hospital mortality (0.889 versus 0.845, P < 0.001) and complications (0.728 versus 0.719, P = 0.037). Reclassification of patients lead to a net reclassification improvement of 6.8%. Additionally, both original Zwolle score low-risk patients and non-low-risk patients who had a Δ-sCr ≥0.3 mg/dl had higher 30-day mortality (low-risk: 1% versus 6.6%, P < 0.001; non-low-risk 4.4% versus 20.7%, P < 0.001), in-hospital mortality and complications. CONCLUSION Δ-sCr enhanced the performance of Zwolle score and was associated with higher 30-day mortality, in-hospital mortality and complications in low and non-low-risk patients. This data may assist the selection of low-risk patients who will safely benefit from early discharge after STEMI.
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Affiliation(s)
| | - António Gomes
- General Surgery Department, Hospital Professor Doutor Fernando Fonseca, Amadora
| | - Pedro Semedo
- Cardiology Department, Hospital do Espírito Santo, Évora
| | | | | | | | - João Pais
- Cardiology Department, Hospital do Espírito Santo, Évora
| | - Ana Rita Rocha
- Cardiology Department, Hospital do Espírito Santo, Évora
| | - Kisa Congo
- Cardiology Department, Hospital do Espírito Santo, Évora
| | - David Neves
- Cardiology Department, Hospital do Espírito Santo, Évora
- CRIA/Cerebro-Cardiovascular Responsability Center, Hospital do Espírito Santo/University of Évora, Évora, Portugal
| | - Ângela Bento
- Cardiology Department, Hospital do Espírito Santo, Évora
- CRIA/Cerebro-Cardiovascular Responsability Center, Hospital do Espírito Santo/University of Évora, Évora, Portugal
| | - Renato Fernandes
- Cardiology Department, Hospital do Espírito Santo, Évora
- CRIA/Cerebro-Cardiovascular Responsability Center, Hospital do Espírito Santo/University of Évora, Évora, Portugal
| | - Manuel Trinca
- Cardiology Department, Hospital do Espírito Santo, Évora
| | - Lino Patrício
- Cardiology Department, Hospital do Espírito Santo, Évora
- CRIA/Cerebro-Cardiovascular Responsability Center, Hospital do Espírito Santo/University of Évora, Évora, Portugal
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Lim TW, Karim TS, Fernando M, Haydar J, Lightowler R, Yip B, Sriamareswaran R, Tong DC, Layland J. Utility of Zwolle Risk Score in Guiding Low-Risk STEMI Discharge. Heart Lung Circ 2020; 30:489-495. [PMID: 33277179 DOI: 10.1016/j.hlc.2020.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/10/2019] [Accepted: 08/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite emerging evidence suggesting that selected patients presenting with ST-segment elevation myocardial infarction (STEMI) treated successfully with primary percutaneous coronary intervention (PPCI) may be considered for early discharge, STEMI patients are typically hospitalised longer to monitor for serious complications. METHODS We assessed the feasibility of identifying low-risk STEMI patients in our institution for early discharge using the Zwolle risk score (ZRS). We evaluated consecutive STEMI patients who underwent successful PPCI within the period 1 January 2016 to 31 December 2017. Low-risk was defined as ZRS≤3. Demographic, angiographic characteristics, length of stay (LOS), and 30-day major adverse cardiovascular events (MACE) defined as cardiac death, stroke, congestive cardiac failure, and non-fatal myocardial infarction, were recorded. RESULTS There were 183 STEMI patients in our study cohort (mean age 62.0±12.2 years, 77.0% male). The median ZRS was 2 (interquartile range 1-4) with 132 (72.1%) patients classified as low-risk. The overall 30-day MACE and mortality rates were 10.4% and 3.3% respectively. None of the 35 (26.5%) low-risk patients who were discharged within 72 hours experienced MACE at 30 days. Low-risk STEMI patients had significantly shorter median LOS (86.3 vs. 93.2 hours, p=0.002), lower 30-day MACE (4.5% vs. 25.5%, p<0.0001) and mortality (0% vs. 11.8%, p<0.0001) compared to high-risk group (ZRS>3). Receiver operating characteristic (ROC) curve analyses for ZRS in predicting 30-day MACE and mortality yielded C-statistics of 0.79 (95%CI 0.68-0.90, p<0.0001) and 0.98 (95%CI 0.95-1.00, p<0.0001) respectively. CONCLUSION Low-risk STEMI patients stratified by Zwolle risk score, who were treated successfully with PPCI, experienced low 30-day MACE and mortality rates, indicating that early discharge may be safe in these patients. Larger studies are warranted to evaluate the safety of ZRS-guided early discharge of STEMI patients, as well as the economic and psychological impacts.
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Affiliation(s)
- Teik Wen Lim
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia
| | | | - Melinda Fernando
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia
| | - Joaud Haydar
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia
| | - Rachel Lightowler
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia
| | - Bryan Yip
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia
| | | | - David C Tong
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia
| | - Jamie Layland
- Department of Cardiology, Peninsula Health, Melbourne, Vic, Australia; Department of Medicine, Monash University, Melbourne, Vic, Australia.
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Banga S, Gumm DC, Kizhakekuttu TJ, Emani VK, Singh S, Singh S, Kaur H, Wang Y, Mungee S. Left Ventricular Ejection Fraction along with Zwolle Risk Score for Risk Stratification to Enhance Safe and Early Discharge in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Retrospective Observational Study. Cureus 2019; 11:e5272. [PMID: 31583196 PMCID: PMC6768833 DOI: 10.7759/cureus.5272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Zwolle risk score (ZRS) is a validated scoring system to determine the time of discharge in ST-segment elevation myocardial infarction (STEMI) patients. Left ventricular ejection fraction (LVEF) also provides prognostic information after ST-elevation myocardial infarction (STEMI). We studied that the addition of LVEF to ZRS variable can improve decision making in safe and early discharge in STEMI patients post-primary coronary intervention. Methods Overall, 249 STEMI patients were studied retrospectively. LVEF was considered as an independent variable. The patients having LVEF <50% were under Group A and LVEF ≥50% were under Group B. Groups were analyzed by model comparison for overall hospital length of stay (LOS) and Intensive care unit (ICU) LOS post-primary percutaneous coronary intervention (PCI). Results There were 123 patients in Group A and 126 patients in Group B. Comparison for primary outcomes showed significant difference with hospital length of stay (LOS) being 3.1 ± 2.3 days in Group A versus 2.1 ± 0.8 days in Group B (p < 0.001). Similarly, ICU stay was also significantly higher in Group A with 36.5 ± 31.4 hours versus 24.0 ± 11.8 hours for Group B, which led to prolonged hospitalization for patients with LVEF <50%. Model 1 that considers ZRS individually is nested within Model 2 where ZRS and LVEF are considered together. The profile log-likelihood ratio test favors model 2 over model 1 (p < 0.0001). Similarly for ICU LOS, R2 = 0.12 (Model 1) < R2 = 0.20 (Model 2). The F test favors model 2 over model 1 (p < 0.0001). Conclusion We concluded that adding LVEF to Zwolle risk score gives a better model for risk stratification in STEMI patients to decide early and safe discharge post-primary PCI.
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Affiliation(s)
- Sandeep Banga
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | - Darrel C Gumm
- Cardiology, University of Illinois College of Medicine at Peoria, Order of St. Francis Medical Centre, Peoria, USA
| | - Tinoy J Kizhakekuttu
- Cardiology, University of Illinois College of Medicine at Peoria, Order of St. Francis Medical Centre, Peoria, USA
| | - Vamsi K Emani
- Internal Medicine, University of Illinois College of Medicine at Peoria, Order of St. Francis Medical Centre, Peoria, USA
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Harleen Kaur
- Neurology, Univeristy of Missouri, Columbia, USA
| | - Yanzhi Wang
- Epidemiology and Public Health, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sudhir Mungee
- Cardiology, University of Illinois College of Medicine, Order of St. Francis Medical Centre, Peoria, USA
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Gong W, Li A, Ai H, Shi H, Wang X, Nie S. Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials. Eur J Prev Cardiol 2018. [PMID: 29537296 DOI: 10.1177/2047487318763823] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early discharge after successful primary angioplasty is common, but the evidence supporting the practice is still lacking. We therefore performed a meta-analysis assessing the safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction (STEMI). Methods Randomised controlled trials were identified and extracted from PubMed, Embase, Cochrane Library databases and reference lists of relevant papers. Heterogeneity was analysed using the I2 test. If there was a lack of heterogeneity, fixed effects models would be used for the meta-analysis, otherwise random effects models were used. Statistical analyses were performed using Review Manager 5.3. Results Five randomised controlled trials involving 1575 STEMI patients met the criteria. Meta-analysis showed that the early discharge strategy group had a significantly shortened length of hospital stay compared to the conventional discharge strategy group (standardised mean difference -1.46, 95% confidence interval (CI) -2.04 to -0.88; P < 0.0001), and there was no difference in mortality and readmission rates between the two groups (risk ratio 0.78, 95% CI 0.50 to 1.22; P = 0.41). Conclusions The findings of this meta-analysis suggested that the early discharge strategy after successful primary angioplasty is safe among selected low-risk STEMI patients. A shorter hospital stay could benefit both the patients and the healthcare systems.
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Affiliation(s)
- Wei Gong
- 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, China.,2 Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China
| | - Aobo Li
- 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, China.,2 Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China
| | - Hui Ai
- 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, China.,2 Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China
| | - Han Shi
- 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, China.,2 Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China
| | - Xiao Wang
- 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, China.,2 Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China
| | - Shaoping Nie
- 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, China.,2 Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China
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Chrysohoou C, Georgiopoulos G, Kosyfa H, Kotsopoulou Haritou I, Kouvari M, Filippou A, Iosifidis S, Tsiamis E, Aggelopoulos P, Pitsavos C, Tousoulis D. Brain Natriuretic Peptide mediates the prognostic role of renal function toward 10-year cardiovascular mortality in patients with Acute Coronary Syndrome: the HHF study (2006–2016). Hellenic J Cardiol 2018; 59:110-118. [DOI: 10.1016/j.hjc.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/01/2017] [Accepted: 07/03/2017] [Indexed: 01/12/2023] Open
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Cerit L. Determinants of safety of early discharge after primary percutaneous coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Determinants of safety of early discharge after primary percutaneous coronary intervention. Rev Port Cardiol 2016; 36:71. [PMID: 27988229 DOI: 10.1016/j.repc.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/17/2016] [Indexed: 11/23/2022] Open
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