Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry
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GIUSEPPE, De Luca; Magdy ALGOWHARY; Berat UGUZ; Dinaldo C OLIVEIRA; Vladimir GANYUKOV; Zan ZIMBAKOV; Miha CERCEK; Lisette Okkels JENSEN; Poay Huan LOH; Lucian CALMAC; Gerard FERRER; Alexandre QUADROS; Marek MILEWSKI; Di Uccio Fortunato SCOTTO; von Birgelen CLEMENS; Francesco VERSACI; Ten Berg JURRIEN; Gianni CASELLA; Aaron Wong Sung LUNG; Petr KALA; Diez Gil Jose LUIS; Xavier CARRILLO; Maurits T DIRKSEN; Victor Manuel BECERRA-MUNOZ; Michael Kang-yin LEE; Dafsah Arifa JUZAR; de Moura Joaquim RODRIGO; Roberto PALADINO; Davor MILICIC; Periklis DAVLOUROS; Nikola BAKRACESKI; Filippo ZILIO; Luca DONAZZAN; Adriaan KRAAIJEVELD; Gennaro GALASSO; Lux ARPAD; Lucia MARINUCCI; Vincenzo GUIDUCCI; Maurizio MENICHELLI; Alessandra SCOCCIA; Aylin Hatice YAMAC; Kadir Ugur MERT; Xacobe Flores RIOS; Tomas KOVARNIK; Michal KIDAWA; Jose MOREU; Flavien VINCENT; Enrico FABRIS; Inigo Lozano MARTINEZ-LUENGAS; Marco BOCCALATTE; Francisco Bosa OJEDA; Carlos ARELLANO-SERRANO; Gianluca CAIAZZO; Giuseppe CIRRINCIONE; Hsien-Li KAO; Juan Sanchis FORES; Luigi VIGNALI; Helder PEREIRA; Stephane MANZO-SILBERMANN; Santiago ORDONEZ; Alev Arat OZKAN; Bruno SCHELLER; Heidi LEHTOLA; Rui TELES; Christos MANTIS; Ylitalo ANTTI; Joao Antonio Brum SILVEIRA; Rodrigo ZONI; Ivan BESSONOV; Stefano SAVONITTO; George KOCHIADAKIS; Dimitrios ALEXOPOULOS; Carlos E URIBE; John KANAKAKIS; Benjamin FAURIE; Gabriele GABRIELLI; Alejandro Gutierrez BARRIOS; Juan Pablo BACHINI; Alex ROCHA; Frankie Chor-Cheung TAM; Alfredo RODRIGUEZ; Antonia Anna LUKITO; Veauthyelau SAINT-JOY; Gustavo PESSAH; Giuliana CORTESE; Guido PARODI; Mohammed Abed BURGADHA; Elvin KEDHI; Pablo LAMELAS; Harry SURYAPRANATA; Matteo NARDIN a Monica VERDOIA
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CURRENT VASCULAR PHARMACOLOGY, SHARJAH, BENTHAM SCIENCE PUBL LTD, 2026, 1570-1611
Background: Several scores have been developed to facilitate risk stratification and early discharge following primary angioplasty, particularly the Zwolle Risk Score (ZRS). However, validation in large-sized studies is still lacking. Therefore, the aim of the current study was to validate the use of the ZRS in a contemporary global population, including patients who were treated during the SARS-CoV-2 pandemic and enrolled in a large intercontinental observational study. Methods: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia, and NorthAfrica, including patients treated from March 1st until June 30th, in 2019 and 2020]. ZRS was calculated for each patient. The patients were additionally categorized according to the following values of the ZRS [<= 3; 4-6; 7-9; >= 10]. Our study outcomes were in-hospital and 30-day mortality. The discriminatory capacity of the ZRS was assessed by the area under the ROC curve [c statistic] as an index of model performance. Results: Our population is represented by 16084 STEMI patients undergoing mechanical reperfusion enrolled in 109 centers. The score showed a very good performance in the predicting mortality both in-hospital [AUC=0.83 [0.82-0.85], p<0.0001] and at 30-day follow-up [AUC=0.82 [0.81-0.84, p<0.0001]. The results were confirmed when the ZRS was separately applied to patients treated in 2019 and 2020, with good stability across time. ZRS was able to identify a large cohort [n=10672, 66.3%] of low-risk patients [score <= 3] with a very low mortality rate at 2 days [1%] and between 3 and 10 days [0.7%], with a very good negative predictive value for in-hospital [98.3%] and 30-day mortality [97.7%], with similar results in 2019 and 2020. Conclusion: This study is the first to demonstrate the good prognostic performance of the ZRS in a large-scale contemporary global multicenter validation set. Similar results were obtained both in the pre-pandemic and the COVID-19 era. ZRS <= 3 identified a very low-risk population that could be discharged early, even during the COVID-19 pandemic, with expected advantages in the availability of hospital beds and nursing staff, costs of medical care, and in-hospital risk of contagion.
GIUSEPPE, De Luca; Magdy ALGOWHARY; Berat UGUZ; Dinaldo C OLIVEIRA; Vladimir GANYUKOV; Zan ZIMBAKOV; Miha CERCEK; Lisette Okkels JENSEN; Poay Huan LOH; Lucian CALMAC; Gerard FERRER; Alexandre QUADROS; Marek MILEWSKI; Di Uccio Fortunato SCOTTO; von Birgelen CLEMENS; Francesco VERSACI; Ten Berg JURRIEN; Gianni CASELLA; Aaron Wong Sung LUNG; Petr KALA; Diez Gil Jose LUIS; Xavier CARRILLO; Maurits T DIRKSEN; Victor Manuel BECERRA-MUNOZ; Michael Kang-yin LEE; Dafsah Arifa JUZAR; de Moura Joaquim RODRIGO; Roberto PALADINO; Davor MILICIC; Periklis DAVLOUROS; Nikola BAKRACESKI; Filippo ZILIO; Luca DONAZZAN; Adriaan KRAAIJEVELD; Gennaro GALASSO; Lux ARPAD; Lucia MARINUCCI; Vincenzo GUIDUCCI; Maurizio MENICHELLI; Alessandra SCOCCIA; Aylin Hatice YAMAC; Kadir Ugur MERT; Xacobe Flores RIOS; Tomas KOVARNIK; Michal KIDAWA; Jose MOREU; Flavien VINCENT; Enrico FABRIS; Inigo Lozano MARTINEZ-LUENGAS; Marco BOCCALATTE; Francisco Bosa OJEDA; Carlos ARELLANO-SERRANO; Gianluca CAIAZZO; Giuseppe CIRRINCIONE; Hsien-Li KAO; Juan Sanchis FORES; Luigi VIGNALI; Helder PEREIRA; Stephane MANZO-SILBERMANN; Santiago ORDONEZ; Alev Arat OZKAN; Bruno SCHELLER; Heidi LEHTOLA; Rui TELES; Christos MANTIS; Ylitalo ANTTI; Joao Antonio Brum SILVEIRA; Rodrigo ZONI; Ivan BESSONOV; Stefano SAVONITTO; George KOCHIADAKIS; Dimitrios ALEXOPOULOS; Carlos E URIBE; John KANAKAKIS; Benjamin FAURIE; Gabriele GABRIELLI; Alejandro Gutierrez BARRIOS; Juan Pablo BACHINI; Alex ROCHA; Frankie Chor-Cheung TAM; Alfredo RODRIGUEZ; Antonia Anna LUKITO; Veauthyelau SAINT-JOY; Gustavo PESSAH; Giuliana CORTESE; Guido PARODI; Mohammed Abed BURGADHA; Elvin KEDHI; Pablo LAMELAS; Harry SURYAPRANATA; Matteo NARDIN a Monica VERDOIA. Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry. CURRENT VASCULAR PHARMACOLOGY. SHARJAH: BENTHAM SCIENCE PUBL LTD, 2026, 8 s. ISSN 1570-1611. Dostupné z: https://doi.org/10.2174/0115701611335913250408214530.
@article{2558050, author = {Giuseppe, De Luca and Algowhary, Magdy and Uguz, Berat and Oliveira, Dinaldo C and Ganyukov, Vladimir and Zimbakov, Zan and Cercek, Miha and Jensen, Lisette Okkels and Loh, Poay Huan and Calmac, Lucian and Ferrer, Gerard and Quadros, Alexandre and Milewski, Marek and Scotto, Di Uccio Fortunato and Clemens, von Birgelen and Versaci, Francesco and Jurrien, Ten Berg and Casella, Gianni and Lung, Aaron Wong Sung and Kala, Petr and Luis, Diez Gil Jose and Carrillo, Xavier and Dirksen, Maurits T and BecerraandMunoz, Victor Manuel and Lee, Michael Kangandyin and Juzar, Dafsah Arifa and Rodrigo, de Moura Joaquim and Paladino, Roberto and Milicic, Davor and Davlouros, Periklis and Bakraceski, Nikola and Zilio, Filippo and Donazzan, Luca and Kraaijeveld, Adriaan and Galasso, Gennaro and Arpad, Lux and Marinucci, Lucia and Guiducci, Vincenzo and Menichelli, Maurizio and Scoccia, Alessandra and Yamac, Aylin Hatice and Mert, Kadir Ugur and Rios, Xacobe Flores and Kovarnik, Tomas and Kidawa, Michal and Moreu, Jose and Vincent, Flavien and Fabris, Enrico and MartinezandLuengas, Inigo Lozano and Boccalatte, Marco and Ojeda, Francisco Bosa and ArellanoandSerrano, Carlos and Caiazzo, Gianluca and Cirrincione, Giuseppe and Kao, HsienandLi and Fores, Juan Sanchis and Vignali, Luigi and Pereira, Helder and ManzoandSilbermann, Stephane and Ordonez, Santiago and Ozkan, Alev Arat and Scheller, Bruno and Lehtola, Heidi and Teles, Rui and Mantis, Christos and Antti, Ylitalo and Silveira, Joao Antonio Brum and Zoni, Rodrigo and Bessonov, Ivan and Savonitto, Stefano and Kochiadakis, George and Alexopoulos, Dimitrios and Uribe, Carlos E and Kanakakis, John and Faurie, Benjamin and Gabrielli, Gabriele and Barrios, Alejandro Gutierrez and Bachini, Juan Pablo and Rocha, Alex and Tam, Frankie ChorandCheung and Rodriguez, Alfredo and Lukito, Antonia Anna and SaintandJoy, Veauthyelau and Pessah, Gustavo and Cortese, Giuliana and Parodi, Guido and Burgadha, Mohammed Abed and Kedhi, Elvin and Lamelas, Pablo and Suryapranata, Harry and Nardin, Matteo and Verdoia, Monica}, article_location = {SHARJAH}, doi = {https://doi.org/10.2174/0115701611335913250408214530}, keywords = {Zwolle Risk Score; STEMI patients; COVID-19 registry; mechanical reperfusion; pandemic}, language = {eng}, issn = {1570-1611}, journal = {CURRENT VASCULAR PHARMACOLOGY}, title = {Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry}, year = {2026} }
TY - JOUR ID - 2558050 AU - Giuseppe, De Luca - Algowhary, Magdy - Uguz, Berat - Oliveira, Dinaldo C - Ganyukov, Vladimir - Zimbakov, Zan - Cercek, Miha - Jensen, Lisette Okkels - Loh, Poay Huan - Calmac, Lucian - Ferrer, Gerard - Quadros, Alexandre - Milewski, Marek - Scotto, Di Uccio Fortunato - Clemens, von Birgelen - Versaci, Francesco - Jurrien, Ten Berg - Casella, Gianni - Lung, Aaron Wong Sung - Kala, Petr - Luis, Diez Gil Jose - Carrillo, Xavier - Dirksen, Maurits T - Becerra-Munoz, Victor Manuel - Lee, Michael Kang-yin - Juzar, Dafsah Arifa - Rodrigo, de Moura Joaquim - Paladino, Roberto - Milicic, Davor - Davlouros, Periklis - Bakraceski, Nikola - Zilio, Filippo - Donazzan, Luca - Kraaijeveld, Adriaan - Galasso, Gennaro - Arpad, Lux - Marinucci, Lucia - Guiducci, Vincenzo - Menichelli, Maurizio - Scoccia, Alessandra - Yamac, Aylin Hatice - Mert, Kadir Ugur - Rios, Xacobe Flores - Kovarnik, Tomas - Kidawa, Michal - Moreu, Jose - Vincent, Flavien - Fabris, Enrico - Martinez-Luengas, Inigo Lozano - Boccalatte, Marco - Ojeda, Francisco Bosa - Arellano-Serrano, Carlos - Caiazzo, Gianluca - Cirrincione, Giuseppe - Kao, Hsien-Li - Fores, Juan Sanchis - Vignali, Luigi - Pereira, Helder - Manzo-Silbermann, Stephane - Ordonez, Santiago - Ozkan, Alev Arat - Scheller, Bruno - Lehtola, Heidi - Teles, Rui - Mantis, Christos - Antti, Ylitalo - Silveira, Joao Antonio Brum - Zoni, Rodrigo - Bessonov, Ivan - Savonitto, Stefano - Kochiadakis, George - Alexopoulos, Dimitrios - Uribe, Carlos E - Kanakakis, John - Faurie, Benjamin - Gabrielli, Gabriele - Barrios, Alejandro Gutierrez - Bachini, Juan Pablo - Rocha, Alex - Tam, Frankie Chor-Cheung - Rodriguez, Alfredo - Lukito, Antonia Anna - Saint-Joy, Veauthyelau - Pessah, Gustavo - Cortese, Giuliana - Parodi, Guido - Burgadha, Mohammed Abed - Kedhi, Elvin - Lamelas, Pablo - Suryapranata, Harry - Nardin, Matteo - Verdoia, Monica PY - 2026 TI - Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry JF - CURRENT VASCULAR PHARMACOLOGY PB - BENTHAM SCIENCE PUBL LTD SN - 15701611 KW - Zwolle Risk Score KW - STEMI patients KW - COVID-19 registry KW - mechanical reperfusion KW - pandemic N2 - Background: Several scores have been developed to facilitate risk stratification and early discharge following primary angioplasty, particularly the Zwolle Risk Score (ZRS). However, validation in large-sized studies is still lacking. Therefore, the aim of the current study was to validate the use of the ZRS in a contemporary global population, including patients who were treated during the SARS-CoV-2 pandemic and enrolled in a large intercontinental observational study. Methods: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia, and NorthAfrica, including patients treated from March 1st until June 30th, in 2019 and 2020]. ZRS was calculated for each patient. The patients were additionally categorized according to the following values of the ZRS [<= 3; 4-6; 7-9; >= 10]. Our study outcomes were in-hospital and 30-day mortality. The discriminatory capacity of the ZRS was assessed by the area under the ROC curve [c statistic] as an index of model performance. Results: Our population is represented by 16084 STEMI patients undergoing mechanical reperfusion enrolled in 109 centers. The score showed a very good performance in the predicting mortality both in-hospital [AUC=0.83 [0.82-0.85], p<0.0001] and at 30-day follow-up [AUC=0.82 [0.81-0.84, p<0.0001]. The results were confirmed when the ZRS was separately applied to patients treated in 2019 and 2020, with good stability across time. ZRS was able to identify a large cohort [n=10672, 66.3%] of low-risk patients [score <= 3] with a very low mortality rate at 2 days [1%] and between 3 and 10 days [0.7%], with a very good negative predictive value for in-hospital [98.3%] and 30-day mortality [97.7%], with similar results in 2019 and 2020. Conclusion: This study is the first to demonstrate the good prognostic performance of the ZRS in a large-scale contemporary global multicenter validation set. Similar results were obtained both in the pre-pandemic and the COVID-19 era. ZRS <= 3 identified a very low-risk population that could be discharged early, even during the COVID-19 pandemic, with expected advantages in the availability of hospital beds and nursing staff, costs of medical care, and in-hospital risk of contagion. ER -
GIUSEPPE, De Luca; Magdy ALGOWHARY; Berat UGUZ; Dinaldo C OLIVEIRA; Vladimir GANYUKOV; Zan ZIMBAKOV; Miha CERCEK; Lisette Okkels JENSEN; Poay Huan LOH; Lucian CALMAC; Gerard FERRER; Alexandre QUADROS; Marek MILEWSKI; Di Uccio Fortunato SCOTTO; von Birgelen CLEMENS; Francesco VERSACI; Ten Berg JURRIEN; Gianni CASELLA; Aaron Wong Sung LUNG; Petr KALA; Diez Gil Jose LUIS; Xavier CARRILLO; Maurits T DIRKSEN; Victor Manuel BECERRA-MUNOZ; Michael Kang-yin LEE; Dafsah Arifa JUZAR; de Moura Joaquim RODRIGO; Roberto PALADINO; Davor MILICIC; Periklis DAVLOUROS; Nikola BAKRACESKI; Filippo ZILIO; Luca DONAZZAN; Adriaan KRAAIJEVELD; Gennaro GALASSO; Lux ARPAD; Lucia MARINUCCI; Vincenzo GUIDUCCI; Maurizio MENICHELLI; Alessandra SCOCCIA; Aylin Hatice YAMAC; Kadir Ugur MERT; Xacobe Flores RIOS; Tomas KOVARNIK; Michal KIDAWA; Jose MOREU; Flavien VINCENT; Enrico FABRIS; Inigo Lozano MARTINEZ-LUENGAS; Marco BOCCALATTE; Francisco Bosa OJEDA; Carlos ARELLANO-SERRANO; Gianluca CAIAZZO; Giuseppe CIRRINCIONE; Hsien-Li KAO; Juan Sanchis FORES; Luigi VIGNALI; Helder PEREIRA; Stephane MANZO-SILBERMANN; Santiago ORDONEZ; Alev Arat OZKAN; Bruno SCHELLER; Heidi LEHTOLA; Rui TELES; Christos MANTIS; Ylitalo ANTTI; Joao Antonio Brum SILVEIRA; Rodrigo ZONI; Ivan BESSONOV; Stefano SAVONITTO; George KOCHIADAKIS; Dimitrios ALEXOPOULOS; Carlos E URIBE; John KANAKAKIS; Benjamin FAURIE; Gabriele GABRIELLI; Alejandro Gutierrez BARRIOS; Juan Pablo BACHINI; Alex ROCHA; Frankie Chor-Cheung TAM; Alfredo RODRIGUEZ; Antonia Anna LUKITO; Veauthyelau SAINT-JOY; Gustavo PESSAH; Giuliana CORTESE; Guido PARODI; Mohammed Abed BURGADHA; Elvin KEDHI; Pablo LAMELAS; Harry SURYAPRANATA; Matteo NARDIN a Monica VERDOIA. Validation of the Zwolle Risk Score in STEMI Patients Undergoing Primary PCI: Insights from the ISCAS-STEMI COVID-19 Registry. \textit{CURRENT VASCULAR PHARMACOLOGY}. SHARJAH: BENTHAM SCIENCE PUBL LTD, 2026, 8 s. ISSN~1570-1611. Dostupné z: https://doi.org/10.2174/0115701611335913250408214530.