The Application Value Of ZWOLLE Scoring In The Prognosis Of STEMI PCI Patients

Background and Aim: With the rapid development of economy and society in the 21 st century,more and more modern people suffer from Coronary Heart Disease(CHD).ST-segment Elevation Myocardial infarction(STEMI)isone of the most dangerous points in patients with CHD.Despite the promising results of STEMI reperfusion therapy,the mortality rates in different patient categories and the safety of early discharge remain controversial.How to accurately identify high-risk and low-risk patients is crucial to improve the prognosis of patients and rational allocation of medical resources.Despite the proliferation of multiple Risk score(RS)models(such as TIMI RS,CRUSADE RS,PAMI RS,etc.)with the increasing incidence of CHD,few are dedicated to the Risk score for STEMI PCI patients.ZWOLLE RS is a practical score based on STEMI PCI patients,and the original study found that it had a predictive value of up to 0.91 for30-day death and predicted the feasibility of early discharge of low-risk patients after PCI.However,due to its late development and the lack of large-scale external validation,the clinical applicability and scope of application of the score are controversial.GRACE RS(Global Registry of Acute Coronary Events Risk score)is recommended by the European society of cardiology hospital tool of a good and long term Risk stratification of Acute Coronary Syndrome(ACS)hospital and discharged after Major cardiovascular Events(MACE)has a high predictive value.Taking GRACE score as the standard,this study analyzed the application value of ZWOLLE RS in STEMI PCI patients by comparing the predictive value of ZWOLLE RS and GRACE RS in hospital and long-term MACE events for STEMI PCI patients,aiming to find a rapid and effective score,early assessment of patients' conditions and assist clinical decision-making.Methods: From February 2016 to February 2017,a total of 420 patients were admitted to the first affiliated hospital of Dalian Medical Universityfor the first time because of STEMI and successfully underwent PCI.General clinical data,biochemical indexes,electrocardiogram changes,coronary TIMI blood flow grading after PCI,and GRACE and ZWOLLE scores were retrospectively analyzed between the two groups,and patients were divided into three groups: low,medium and high risk.The incidence of MACE events within 2 years was observed.SPSS 22.0 was used for correlation statistical analysis.Results :1.Stratified analysis and comparison of GRACE evaluation: the low,medium and high risk groups were 1.8%,6.1% and 7.5% respectively.Comparison of the 6-month incidence of MACE events: the low,medium and high risk groups were 4.5%,7.3% and11.6%.Comparison of 1-year MACE incidence: low risk,medium risk,high risk: 10%,11%,19.9%;Comparison of MACE events in 2 years: 10.9% in low-risk group,13.4%in medium-risk group and 21.9% in high-risk group;Interlayer analysis showed that in the prediction of MACE events at 30 days,6 months,1 year and 2 years,the probability of MACE events was significantly higher in the GRACE RS high-risk group than the low-risk group(P < 0.05),and there was no significant difference between the low-risk group and the medium-risk group(P > 0.05).2.ZWOLLE's stratified analysis and comparison: the low,medium and high risk groups were 2.5%,8.0% and 26.3%.The incidence of MACE events at 6 months was5.8% in the low-risk group,10.1% in the medium-risk group,and 21.1% in the high-risk group.Comparison of 1-year MACE incident rate: 9.1% in low-risk group,18.4% in medium-risk group,36.8% in high-risk group;Comparison of MACE events in 2 years:11.1% in low-risk group,20.3% in medium-risk group,36.8% in high-risk group;Interlayer analysis shows that in 30 days,6 months,1 year and 2 years of MACE events forecast,MACE in high-risk group event probability is significantly higher than low risk group(P < 0.05),except for 2 years MACE events forecast,the rest of the interlayer high-risk group and intermediate risk group for comparison to find score between MACE event probability there was no significant difference(P > 0.05).3.Correlation analysis:In the studies on the relationship between MACE events of GRACE and ZWOLLE RS and the subjects at 30 days,6 months,1 year and 2 years,there were significant differences between the two groups(P < 0.05).The correlation analysis showed that the 30-day r value was 0.764,the 6-month r value was 0.707,the1-year r value was 0.712,and the 2-year r value was 0.683,showing a significant correlation.The ROC curve analysis of the two scores showed that GRACE and ZWOLLE RS had high predictive value in the 30-day retrospective analysis of STEMI PCI patients.Their aucs were 0.725 and 0.700 respectively.The aucs of 6 months,1year and 2 years were 0.637,0.606,0.605 VS 0.621,0.636 and 0.612.4.Predictive value of Heart Failure:GRACE RS and ZWOLLE RS have certain predictive value for the occurrence of Heart Failure after STEMI PCI(AUC: 0.700 and0.76).5.ZWOLLE score risk stratification:The incidence of non-MACE events in ZWOLLE RS ? 3 group was significantly different from that in ZWOLLE RS > 3 group(90 VS78%,P < 0.05).The negative predictive value of 2-year MACE event was 90%.Conclusion:1.ZWOLLE RS can be used as postoperative prediction score for STEMI PCI patients.2.ZWOLLE RS can accurately identify high-risk patients with simple operation.3.ZWOLLE and GRACE RS have good predictive value for the occurrence of heart failure in STEMI PCI patients.Moreover,the accuracy and sensitivity of ZWOLLE RS in predicting the occurrence of heart failure were higher than that of GRACE RS.4.ZWOLLE RS can accurately identify low-risk patients and provide evidence for early discharge of low-risk patients,which GRACE RS cannot evaluate.