The Zwolle risk score: Safe early discharge
This score is a practical and useful index for risk stratification after primary angioplasty for ST elevated myocardial infarction (STEMI), with a significant impact on clinical decision-making and the related costs. It reliably identifies a large group of patients at very low risk, who may safely be discharged early after primary angioplasty.
Research authors: Giuseppe de Luca, Harry Suryapranata, Arnoud W.J. van't Hof, Menko-Jan de Boer, Jan C.A. Hoorntje, Jan-Henk E. Dambrink, A.T. Marcel Gosselink, Jan Paul Ottervanger, Felix Zijlstra
Details Formula Study characteristics Files & References
★★★
Model author
Model ID
1189
Version
1.5
Revision date
2018-03-05
Specialty
MeSH terms
  • ST Elevated Myocardial Infarction
  • Myocardial Infarction
  • Angioplasty
  • Model type
    Linear model (Calculation)
    Status
    public
    Rating
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    Formula
    No Formula defined yet
    Condition Formula

    Additional information

    population comprised a total of 1791 patients with STEMI treated by primary angioplasty between August 1994 and October 2001.

    Study Population

    Total population size: 1791
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    Age 60 11 year
    Ischemic time 3.5 1.3 hours
    Predischarge ejection fraction 44 11 %
    Cumulative lactate dehydrogenase enzyme release up to 48 hours 1815 1557 U/L

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Hypertension No 1392
    Yes 399
    Diabetes No 1634
    Yes 157
    Hpercholesterolemia No 1464
    Yes 327
    Smoking No 949
    Yes 842
    Previous infarction No 1587
    Yes 204
    Previous revascularization No 1641
    Yes 150
    Transferred No 1099
    Yes 692
    Anterior infarction or left bundle branch block No 871
    Yes 920
    Killip class 1 1579
    >1 212
    Multivessel disease No 828
    Yes 963
    Left anterior descending artery No 905
    Yes 886
    Preprocedural TIMI 0-1 1321
    2-3 470
    Postprocedural TIMI <3 171
    3 1620
    Procedural succes No 192
    Yes 1599
    Stent No 899
    Yes 892
    30-day mortality Alive 1726
    Dead 65
    The Zwolle risk score: Safe early discharge
    V-1.5-1189.18.03.05
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

    Related files

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    Supporting Publications

    The Zwolle risk score is:
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    Points

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    Result
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    The Zwolle risk score is: Points

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    Outcome stratification

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    Conditional information

    Result interpretation

    This score was able to identify a large cohort (73.4%) of low-risk (score ≤3) patients, with a good discriminatory capacity (c statistic = 0.907). The mortality rate was 0.1% at 2 days and 0.2% between 2 and 10 days in patients with a score ≤3. The incremental cost-effectiveness ratio for late discharge in low-risk patients was estimated at €1949.33. Therefore, this policy would save 1 life per 1097 low-risk patients, at additional costs of €194 933.33, in comparison with an early discharge policy.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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