title: A new prognostic evaluation of patients with acute ST-elevation myocardial infarction undergoing primary angioplasty: combined Zwolle and Syntax score.
abstract: BACKGROUND
  The Zwolle score (Zs) is a validated risk score used to identify low-risk patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Syntax score (Ss) is an angiographic score that evaluates the complexity of coronary artery disease.
  
  
  OBJECTIVE
  We aimed to create a simple risk score by combining these two scores for risk stratification in patients with STEMI undergoing primary PCI.
  
  
  METHODS
  299 consecutive STEMI patients (mean age 57.4 ± 11.7 years, 240 men) who underwent primary PCI were prospectively enrolled into the present study. The study population was divided into tertiles based on admission Zs and Ss. A high Zs (> 3) and high Ss (> 24) were defined as values in the third tertiles. A low Zs and low Ss were defined as values in the lower two tertiles. Patients were then classified into four groups: high Zs and high Ss (HZsHSs, n = 26), high Zs and low Ss (HZsLSs, n = 29), low Zs and high Ss (LZsHSs, n = 48), and low Zs and low Ss (LZsLSs, n = 196). In-hospital cardiacoutcomes were then recorded.
  
  
  RESULTS
  In-hospital cardiovascular mortality was higher in HZsHSs (50%) compared to the HZsLSs (27.5%), LZsHSs (0%), and LZsLSs (0.5%) groups. After adjustment for potentially confounding factors, HZsHSs (OR 77.6, 95% CI 6.69-113.1, p = 0.001), and HZsLSs (OR 28.9, 95% CI 2.77-56.2, p = 0.005) status, but not LZsHSs and LZsLSs status, remained independent predictors of in-hospital cardiovascular mortality.
  
  
  CONCLUSIONS
  STEMI patients with HZsHSs represent the highest risk population for in-hospital cardiovascular mortality.
authors.affiliation: Department of Cardiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey. doktorseref@hotmail.com.
authors.forename: Seref
authors.initials: S
authors.lastname: Kul
authors.forename: Huseyin
authors.initials: H
authors.lastname: Uyarel
authors.forename: Murat
authors.initials: M
authors.lastname: Turfan
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ertas
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Vatankulu
authors.forename: Okkes Taha
authors.initials: OT
authors.lastname: Kucukdagli
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ergelen
authors.forename: Hatice Betul
authors.initials: HB
authors.lastname: Erer
authors.forename: Tolga Sinan
authors.initials: TS
authors.lastname: Guvenc
authors.forename: Omer
authors.initials: O
authors.lastname: Goktekin
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D056988:Anterior Wall Myocardial Infarction / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology