Natriuretic peptides in addition to Zwolle score to enhance safe and early discharge after acute myocardial infarction: A prospective observational cohort study

Abstract Background The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP)...

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Published inInternational journal of cardiology Vol. 215; pp. 527 - 531
Main Authors Ganovska, Eva, Arrigo, Mattia, Helanova, Katerina, Littnerova, Simona, Sadoune, Malha, Kubena, Petr, Pavlusova, Marie, Jarkovsky, Jiri, Gottwaldova, Jana, Kala, Petr, Dastych, Milan, Ishihara, Shiro, Van Aelst, Lucas N.L, Cohen-Solal, Alain, Gayat, Etienne, Spinar, Jindrich, Parenica, Jiri, Mebazaa, Alexandre
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 15.07.2016
Subjects
Aged
BNP
Cardiovascular
Discharge
Female
Humans
Length of Stay
Male
Middle Aged
Myocardial infarction
Natriuretic Peptide, Brain - blood
Prognosis
Prospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
ST Elevation Myocardial Infarction - blood
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - therapy
STEMI
Zwolle
Myocardial infarction
STEMI
BNP
Zwolle
Discharge
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Abstract Abstract Background The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP) also provides prognostic information after STEMI. The aim of the study was to test the hypothesis that patients with high Zwolle score associated with low BNP share similar outcomes than those with low Zwolle score. Methods and results The study population consisted of 1032 consecutive STEMI patients in whom BNP was measured 24 h after chest pain onset. The area under the curve of Zwolle score and plasma BNP for 30-day mortality were 0.82 and 0.87, p = 0.39. A BNP threshold of 200 pg/ml had sensitivity of 100% and specificity of 34% for predicting 30-day mortality. Patients with high Zwolle score and BNP ≤ 200 pg/ml (n = 183) had similar mortality and hospital stay to those with low Zwolle score (0% vs. 0.5% and 5 vs. 5 days, both p = 1.0). By contrast, patients with high Zwolle score and BNP > 200 pg/ml had the highest mortality (6.7%) and the longest hospital stay (6 days), both p < 0.01. Conclusion STEMI patients with high Zwolle score but low BNP share similar outcomes with those with low Zwolle score and should be eligible for early discharge. Hence, using the rule of “low-Zwolle or low-BNP” might increase the number of STEMI patients that might be eligible for early discharge.
AbstractList The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP) also provides prognostic information after STEMI. The aim of the study was to test the hypothesis that patients with high Zwolle score associated with low BNP share similar outcomes than those with low Zwolle score. The study population consisted of 1032 consecutive STEMI patients in whom BNP was measured 24h after chest pain onset. The area under the curve of Zwolle score and plasma BNP for 30-day mortality were 0.82 and 0.87, p=0.39. A BNP threshold of 200pg/ml had sensitivity of 100% and specificity of 34% for predicting 30-day mortality. Patients with high Zwolle score and BNP≤200pg/ml (n=183) had similar mortality and hospital stay to those with low Zwolle score (0% vs. 0.5% and 5 vs. 5days, both p=1.0). By contrast, patients with high Zwolle score and BNP>200pg/ml had the highest mortality (6.7%) and the longest hospital stay (6days), both p<0.01. STEMI patients with high Zwolle score but low BNP share similar outcomes with those with low Zwolle score and should be eligible for early discharge. Hence, using the rule of “low-Zwolle or low-BNP” might increase the number of STEMI patients that might be eligible for early discharge.
BACKGROUNDThe Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP) also provides prognostic information after STEMI. The aim of the study was to test the hypothesis that patients with high Zwolle score associated with low BNP share similar outcomes than those with low Zwolle score.METHODS AND RESULTSThe study population consisted of 1032 consecutive STEMI patients in whom BNP was measured 24h after chest pain onset. The area under the curve of Zwolle score and plasma BNP for 30-day mortality were 0.82 and 0.87, p=0.39. A BNP threshold of 200pg/ml had sensitivity of 100% and specificity of 34% for predicting 30-day mortality. Patients with high Zwolle score and BNP≤200pg/ml (n=183) had similar mortality and hospital stay to those with low Zwolle score (0% vs. 0.5% and 5 vs. 5days, both p=1.0). By contrast, patients with high Zwolle score and BNP>200pg/ml had the highest mortality (6.7%) and the longest hospital stay (6days), both p<0.01.CONCLUSIONSTEMI patients with high Zwolle score but low BNP share similar outcomes with those with low Zwolle score and should be eligible for early discharge. Hence, using the rule of "low-Zwolle or low-BNP" might increase the number of STEMI patients that might be eligible for early discharge.
Background: The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP) also provides prognostic information after STEMI. The aim of the study was to test the hypothesis that patients with high Zwolle score associated with low BNP share similar outcomes than those with low Zwolle score. Methods and results: The study population consisted of 1032 consecutive STEMI patients in whom BNP was measured 24 h after chest pain onset. The area under the curve of Zwolle score and plasma BNP for 30-day mortality were 0.82 and 0.87, p = 0.39. A BNP threshold of 200 pg/ml had sensitivity of 100% and specificity of 34% for predicting 30-day mortality. Patients with high Zwolle score and BNP less than or equal to 200 pg/ml (n = 183) had similar mortality and hospital stay to those with low Zwolle score (0% vs. 0.5% and 5 vs. 5 days, both p = 1.0). By contrast, patients with high Zwolle score and BNP > 200 pg/ml had the highest mortality (6.7%) and the longest hospital stay (6 days), both p < 0.01. Conclusion: STEMI patients with high Zwolle score but low BNP share similar outcomes with those with low Zwolle score and should be eligible for early discharge. Hence, using the rule of "low-Zwolle or low-BNP" might increase the number of STEMI patients that might be eligible for early discharge.
Abstract Background The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP) also provides prognostic information after STEMI. The aim of the study was to test the hypothesis that patients with high Zwolle score associated with low BNP share similar outcomes than those with low Zwolle score. Methods and results The study population consisted of 1032 consecutive STEMI patients in whom BNP was measured 24 h after chest pain onset. The area under the curve of Zwolle score and plasma BNP for 30-day mortality were 0.82 and 0.87, p = 0.39. A BNP threshold of 200 pg/ml had sensitivity of 100% and specificity of 34% for predicting 30-day mortality. Patients with high Zwolle score and BNP ≤ 200 pg/ml (n = 183) had similar mortality and hospital stay to those with low Zwolle score (0% vs. 0.5% and 5 vs. 5 days, both p = 1.0). By contrast, patients with high Zwolle score and BNP > 200 pg/ml had the highest mortality (6.7%) and the longest hospital stay (6 days), both p < 0.01. Conclusion STEMI patients with high Zwolle score but low BNP share similar outcomes with those with low Zwolle score and should be eligible for early discharge. Hence, using the rule of “low-Zwolle or low-BNP” might increase the number of STEMI patients that might be eligible for early discharge.
Author Pavlusova, Marie
Arrigo, Mattia
Ishihara, Shiro
Sadoune, Malha
Dastych, Milan
Spinar, Jindrich
Kubena, Petr
Jarkovsky, Jiri
Cohen-Solal, Alain
Van Aelst, Lucas N.L
Parenica, Jiri
Gottwaldova, Jana
Littnerova, Simona
Kala, Petr
Gayat, Etienne
Helanova, Katerina
Ganovska, Eva
Mebazaa, Alexandre
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Keywords Myocardial infarction
STEMI
BNP
Zwolle
Discharge
Language English
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Snippet Abstract Background The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial...
The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since...
BACKGROUNDThe Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI),...
Background: The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction...
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StartPage 527
SubjectTerms Aged
BNP
Cardiovascular
Discharge
Female
Humans
Length of Stay
Male
Middle Aged
Myocardial infarction
Natriuretic Peptide, Brain - blood
Prognosis
Prospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
ST Elevation Myocardial Infarction - blood
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - therapy
STEMI
Zwolle
Title Natriuretic peptides in addition to Zwolle score to enhance safe and early discharge after acute myocardial infarction: A prospective observational cohort study
URI https://www.clinicalkey.es/playcontent/1-s2.0-S0167527316308245
https://dx.doi.org/10.1016/j.ijcard.2016.04.148
https://www.ncbi.nlm.nih.gov/pubmed/27155548
https://search.proquest.com/docview/1791324977
https://search.proquest.com/docview/1811907244
Volume 215
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