title: 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) 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: evaganovska@gmail.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Ganovska
authors.affiliation: INSERM UMR-S 942, Paris, France; Department of Anesthesiology and Critical Care Medicine, APHP, Saint Louis Lariboisière University Hospitals, Paris, France; Department of Cardiology, APHP, Lariboisière University Hospital, Paris, France; Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. Electronic address: mattia.arrigo@usz.ch.
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: trekar@seznam.cz.
authors.forename: Katerina
authors.initials: K
authors.lastname: Helanova
authors.affiliation: Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic. Electronic address: littnerova@iba.muni.cz.
authors.forename: Simona
authors.initials: S
authors.lastname: Littnerova
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic. Electronic address: malha.sadoune@inserm.fr.
authors.forename: Malha
authors.initials: M
authors.lastname: Sadoune
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: petrkubena@seznam.cz.
authors.forename: Petr
authors.initials: P
authors.lastname: Kubena
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: mpavlusova@seznam.cz.
authors.forename: Marie
authors.initials: M
authors.lastname: Pavlusova
authors.affiliation: Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic. Electronic address: jarkovsky@iba.muni.cz.
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.affiliation: Department of Biochemistry, University Hospital Brno, Brno, Czech Republic; Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic. Electronic address: jgottwaldova@fnbrno.cz.
authors.forename: Jana
authors.initials: J
authors.lastname: Gottwaldova
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: pkala@fnbrno.cz.
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
authors.affiliation: Department of Biochemistry, University Hospital Brno, Brno, Czech Republic; Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic. Electronic address: mdast@fnbrno.cz.
authors.forename: Milan
authors.initials: M
authors.lastname: Dastych
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic. Electronic address: ishiharashiro@hotmail.com.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: INSERM UMR-S 942, Paris, France; Department of Cardiology, APHP, Lariboisière University Hospital, Paris, France; KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium. Electronic address: lucas.vanaelst@med.kuleuven.be.
authors.forename: Lucas N L
authors.initials: LN
authors.lastname: Van Aelst
authors.affiliation: INSERM UMR-S 942, Paris, France; Department of Cardiology, APHP, Lariboisière University Hospital, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, France. Electronic address: alain.cohen-solal@aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.affiliation: INSERM UMR-S 942, Paris, France; Department of Anesthesiology and Critical Care Medicine, APHP, Saint Louis Lariboisière University Hospitals, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, France. Electronic address: etienne.gayat@aphp.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: jspinar@fnbrno.cz.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic. Electronic address: jiri.parenica@atlas.cz.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.affiliation: INSERM UMR-S 942, Paris, France; Department of Anesthesiology and Critical Care Medicine, APHP, Saint Louis Lariboisière University Hospitals, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, France. Electronic address: alexandre.mebazaa@aphp.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: BNP; Discharge; Myocardial infarction; STEMI; Zwolle