Zwolle Risk Score as a Predictor of In-Hospital Mortality in Post Primary Percutaneous Coronary Intervention St-Elevation Myocardial Infarction Patients

Abstract

Objective: To determine the Zwolle Risk Score's (ZRS) prediction accuracy during coronary angiography for clinical outcome in post PCI patients with ST-elevation myocardial infarction keeping in-hospital mortality as primary endpoint.

Study Design: Analytical Cross sectional study

Place and Duration of Study: Adult Cardiology, Armed Forces Institute of Cardiology (AFIC/NNIHD) Rawalpindi, Pakistan from May to Nov 2025

Methodology: Four hundred six STEMI patients of both sexes were enrolled, with age between 18 to 80 years using the non-probability consecutive sampling technique. Patients with NSTEMI, unstable angina, history of PCI or CABG, patients with incomplete clinical data were excluded. ZRS was calculated before the coronary angiography and a score >6 categorized as positive predictor of in-hospital mortality. Every patient was followed up by 72 hours to record mortality outcomes. The parameters of the diagnostic accuracy were determined.

Results: out of Four hundred six patients 311 (76.6%) participants were men. Mean age was 38.75±13.07 years. We analyzed that 95(23.4%) patients were categorized as high risk on the basis of ZRS score while actual in-hospital mortality was counted as 43(10.6%). The study's sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were 81.4%, 83.5%, 36.8%, 97.4%, and 83.3%, respectively.

Conclusion: The ZRS has a satisfactory diagnostic accuracy in predicting early in-hospital mortality in patients with STEMI who underwent PPCI, with a high sensitivity and negative predictive value. Its ability to repeatedly rule out the risk of early death makes ...