Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

array:26 ["pii" => "S0870255115001845" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.04.006" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "671" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:535-41" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4001 "formatos" => array:3 [ "EPUB" => 202 "HTML" => 3141 "PDF" => 658 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S2174204915001853" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.08.005" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "671" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:535-41" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2942 "formatos" => array:3 [ "EPUB" => 179 "HTML" => 2182 "PDF" => 581 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "535" "paginaFinal" => "541" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação da segurança da alta precoce após enfarte agudo do miocárdio com supradesnivelamento do segmento ST submetido a intervenção coronária percutânea primária: o Score de Zwolle" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1567 "Ancho" => 2468 "Tamanyo" => 179685 ] ] "descripcion" => array:1 [ "en" => "Survival curves stratified by Zwolle risk score showing 95% confidence intervals. ZRS: Zwolle risk score." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "António Tralhão, António Miguel Ferreira, Sérgio Madeira, Miguel Borges Santos, Mariana Castro, Ingrid Rosário, Marisa Trabulo, Carlos Aguiar, Jorge Ferreira, Manuel Sousa Almeida, Miguel Mendes" "autores" => array:11 [ 0 => array:2 [ "nombre" => "António" "apellidos" => "Tralhão" ] 1 => array:2 [ "nombre" => "António Miguel" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Madeira" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Borges Santos" ] 4 => array:2 [ "nombre" => "Mariana" "apellidos" => "Castro" ] 5 => array:2 [ "nombre" => "Ingrid" "apellidos" => "Rosário" ] 6 => array:2 [ "nombre" => "Marisa" "apellidos" => "Trabulo" ] 7 => array:2 [ "nombre" => "Carlos" "apellidos" => "Aguiar" ] 8 => array:2 [ "nombre" => "Jorge" "apellidos" => "Ferreira" ] 9 => array:2 [ "nombre" => "Manuel Sousa" "apellidos" => "Almeida" ] 10 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255115001845" "doi" => "10.1016/j.repc.2015.04.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001845?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001853?idApp=UINPBA00004E" "url" => "/21742049/0000003400000009/v1_201509130054/S2174204915001853/v1_201509130054/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255115001821" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.03.009" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "669" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:543-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3549 "formatos" => array:3 [ "EPUB" => 188 "HTML" => 2698 "PDF" => 663 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Autonomic activity and biomarker behavior in supine position and after passive postural stress in different orthostatic intolerance syndromes" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "543" "paginaFinal" => "549" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Atividade autonómica e neurohormonal em doentes com intolerância ortostática durante o supino e após ortostatismo passivo" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "João Freitas, Elsa Azevedo, Rosa Santos, Maria Júlia Maciel, Francisco Rocha-Gonçalves" "autores" => array:5 [ 0 => array:2 [ "nombre" => "João" "apellidos" => "Freitas" ] 1 => array:2 [ "nombre" => "Elsa" "apellidos" => "Azevedo" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Santos" ] 3 => array:2 [ "nombre" => "Maria Júlia" "apellidos" => "Maciel" ] 4 => array:2 [ "nombre" => "Francisco" "apellidos" => "Rocha-Gonçalves" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204915001865" "doi" => "10.1016/j.repce.2015.08.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001865?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001821?idApp=UINPBA00004E" "url" => "/08702551/0000003400000009/v1_201509110034/S0870255115001821/v1_201509110034/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255115001833" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.03.010" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "670" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:529-33" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3360 "formatos" => array:3 [ "EPUB" => 180 "HTML" => 2550 "PDF" => 630 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Permanent pacemaker implantation after aortic valve replacement: Long-term dependency or rhythm recovery?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "529" "paginaFinal" => "533" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Implantação de pacemaker permanente após substituição da válvula aórtica: dependência a longo prazo ou recuperação de ritmo?" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vânia Ribeiro, Raquel Mota Garcia, Cecília Frutuoso, Filipa Melão, Marta Pereira, Paulo Pinho, Maria Júlia Maciel" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Vânia" "apellidos" => "Ribeiro" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Mota Garcia" ] 2 => array:2 [ "nombre" => "Cecília" "apellidos" => "Frutuoso" ] 3 => array:2 [ "nombre" => "Filipa" "apellidos" => "Melão" ] 4 => array:2 [ "nombre" => "Marta" "apellidos" => "Pereira" ] 5 => array:2 [ "nombre" => "Paulo" "apellidos" => "Pinho" ] 6 => array:2 [ "nombre" => "Maria Júlia" "apellidos" => "Maciel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204915001841" "doi" => "10.1016/j.repce.2015.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001841?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001833?idApp=UINPBA00004E" "url" => "/08702551/0000003400000009/v1_201509110034/S0870255115001833/v1_201509110034/en/main.assets" ] "asociados" => array:1 [ 0 => array:20 [ "pii" => "S0870255116303468" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.07.006" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "919" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2017;36:71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2100 "formatos" => array:3 [ "EPUB" => 213 "HTML" => 1476 "PDF" => 411 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Determinants of safety of early discharge after primary percutaneous coronary intervention" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "71" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Determinantes de segurança na alta antecipada após intervenção coronária percutânea primária" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Levent Cerit" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Levent" "apellidos" => "Cerit" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916302793" "doi" => "10.1016/j.repce.2016.12.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302793?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303468?idApp=UINPBA00004E" "url" => "/08702551/0000003600000001/v2_201701040047/S0870255116303468/v2_201701040047/en/main.assets" ] ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "535" "paginaFinal" => "541" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "António Tralhão, António Miguel Ferreira, Sérgio Madeira, Miguel Borges Santos, Mariana Castro, Ingrid Rosário, Marisa Trabulo, Carlos Aguiar, Jorge Ferreira, Manuel Sousa Almeida, Miguel Mendes" "autores" => array:11 [ 0 => array:4 [ "nombre" => "António" "apellidos" => "Tralhão" "email" => array:1 [ 0 => "atralhao@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "António Miguel" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Madeira" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Borges Santos" ] 4 => array:2 [ "nombre" => "Mariana" "apellidos" => "Castro" ] 5 => array:2 [ "nombre" => "Ingrid" "apellidos" => "Rosário" ] 6 => array:2 [ "nombre" => "Marisa" "apellidos" => "Trabulo" ] 7 => array:2 [ "nombre" => "Carlos" "apellidos" => "Aguiar" ] 8 => array:2 [ "nombre" => "Jorge" "apellidos" => "Ferreira" ] 9 => array:2 [ "nombre" => "Manuel Sousa" "apellidos" => "Almeida" ] 10 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação da segurança da alta precoce após enfarte agudo do miocárdio com supradesnivelamento do segmento ST submetido a intervenção coronária percutânea primária: o Score de Zwolle" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1531 "Ancho" => 2379 "Tamanyo" => 123107 ] ] "descripcion" => array:1 [ "en" => "Survival curves stratified by Zwolle risk score showing 95% confidence intervals. ZRS: Zwolle risk score." ] ] ] "textoCompleto" => "IntroductionST-segment elevation myocardial infarction (STEMI) is one the most frequent presentations of acute coronary syndromes. Despite significant reductions in morbidity and mortality due to optimization of reperfusion strategies, some issues are still poorly defined in the current guidelines.<a class="elsevierStyleCrossRefs" href="#bib0100">1,2</a> One of the least studied aspects is the optimal length of stay (LOS) for patients with uncomplicated STEMI. Current practice adopts 5–7 days for monitoring of complications, but this is largely empirical.<a class="elsevierStyleCrossRefs" href="#bib0110">3,4</a> A need to better define the appropriate LOS has been recognized by European and American cardiovascular societies, which suggest the use of prognostic tools to accurately identify low-risk patients who can be safely discharged within 72 hours.<a class="elsevierStyleCrossRefs" href="#bib0100">1,2,5,6</a> The Zwolle risk score (ZRS) is a simple six-item score (age ≥60, time to reperfusion >4 hours, anterior infarct, TIMI flow post angioplasty, three-vessel disease, Killip class; <a class="elsevierStyleCrossRef" href="#sec0075">Appendix 1</a>) that showed promising results in a pivotal study.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> Using the ZRS could potentially improve patient throughput and reduce healthcare costs,<a class="elsevierStyleCrossRefs" href="#bib0120">5,7</a> but any failure to identify patients who will suffer from early complications could have dire consequences and legal implications. The adoption of a targeted early discharge policy should therefore always be preceded by validation in the specific population in which it will be used. We sought to validate the ZRS in our population of STEMI patients and to identify variables associated with increased LOS.MethodsWe conducted an observational retrospective study of all patients with STEMI referred to our center for primary percutaneous coronary intervention (PPCI) between January 2011 and December 2012 (n=278). Of these, two died during the index procedure and were excluded from the analysis, yielding a population of 276 patients admitted to the cardiac intensive care unit. The ZRS was calculated for each patient.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> In this score, each variable is given points for a minimum score of 0 and a maximum of 16 (<a class="elsevierStyleCrossRef" href="#sec0075">Appendix 1</a>). Low risk was defined as ZRS ≤3, as in the original study.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> In the subset of low-risk patients, clinical data were additionally scanned for variables that could influence LOS. LOS was defined as the time (in days) from first balloon inflation to time of hospital discharge. The primary endpoint was 30-day mortality. The secondary endpoint was death or readmission within 30 days of discharge. Mortality and readmissions up to 30 days after discharge were obtained for all patients by reviewing medical charts, supplemented by telephone interview whenever necessary. Informed consent for inclusion in a prospective registry was obtained from all patients.The statistical analysis was performed using SPSS version 21.0 (IBM Corp., Armonk, NY, USA) and MedCalc 6.0 (MedCalc Software, Ostend, Belgium). Differences between groups were tested using the t test and one-way analysis of variance and the K test for medians for continuous variables with a normal and non-normal distribution, respectively. Categorical variables were compared using Fisher's exact test. The log-rank test was used for survival analysis. The clinical usefulness of any predictive score or model relies on its goodness-of-fit and discriminative ability.<a class="elsevierStyleCrossRef" href="#bib0135">8</a> The goodness-of-fit of the ZRS, reflecting how close the predicted 30-day mortality is to that observed, was assessed by a calibration plot and by the calibration-in-the-large statistic.<a class="elsevierStyleCrossRef" href="#bib0135">8</a> The discriminative ability of the ZRS in our population (i.e., the extent to which the score is able to separate survivors from non-survivors) was expressed by the C-statistic, which, for binary outcomes, is equal to the area under the receiver operating characteristic (ROC) curve. Two-tailed p values <0.05 were considered statistically significant.ResultsPatient characteristicsPatient characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>. The median ZRS was 3 (interquartile range [IQR] 1–4), with 171 patients (62%) being classified as low-risk (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Compared to other patients, low-risk patients were younger and had a lower prevalence of hypertension and diabetes and a higher proportion of smokers. The frequency of each component of the ZRS is depicted in <a class="elsevierStyleCrossRef" href="#tbl0035">Table 2</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia>Hospital mortality and Zwolle risk score analysisThirty-day mortality occurred in 13 patients (4.7%). ROC curve analysis yielded a C-statistic of 0.937 (95% CI 0.906–0.968, p<0.001), demonstrating excellent discriminative power (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Calibration-in-the-large was performed using the observed mortality rate of the original study<a class="elsevierStyleCrossRef" href="#bib0130">7</a> compared against this validation cohort, divided into four subgroups (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>), yielding a value of 10.1%, due to a higher mortality rate in the original cohort. Overall, the observed mortality was similar to that predicted by the ZRS, although the latter tended to overestimate the likelihood of fatal events in patients with higher scores.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>When stratified using a cut-off ZRS of 3, a significant difference was found in 30-day survival between patients classified as ZRS ≤3 and ZRS >3 (100 vs. 87.6%, log-rank p<0.0001; <a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>), yielding a negative predictive value of 100% (95% CI 97–100%) for 30-day mortality.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Length of stayMedian LOS was 5 (IQR 4–9) days. Median LOS in the low-risk group was significantly lower (5.0 [IQR 4–7] vs. 7.0 [IQR 5–13] days, p<0.001), with 22% of patients being discharged within 72 hours in the low-risk group vs. 14% in the non-low-risk group (<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>). In the 171 low-risk patients, 38 were discharged in ≤72 hours after the index event. Among the other 133 individuals, 52 had some contraindication for an earlier discharge (e.g. left ventricular thrombus, atrial fibrillation, or bleeding complication). Additional staged revascularization (either percutaneous or surgical) was the most frequent cause for a lengthened stay in this low-risk population. Seven patients also underwent additional ischemia testing. In this low-risk cohort, 81 patients had no discernible medical reason for an increased LOS. These patients represented 221 extra days of stay beyond 72 hours (<a class="elsevierStyleCrossRef" href="#fig0030">Figure 6</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia>No deaths occurred in the 30 days following discharge. Four (1.4%) patients were readmitted in this period (<a class="elsevierStyleCrossRef" href="#tbl0055">Table 3</a>), three in the ZRS ≤3 group and one in the ZRS >3 group (p=1.0).<elsevierMultimedia ident="tbl0055"></elsevierMultimedia>DiscussionIn the absence of formal recommendations on the ideal LOS after uncomplicated STEMI, decisions regarding the time of discharge are usually made on an individual basis, considering the patient's previous comorbidities and immediate clinical course following MI. Our study shows that, in a population of real-world consecutive STEMI patients treated with PPCI, a strategy of early discharge (≤72 hours) guided by the ZRS is feasible and safe in selected low-risk patients. None of these low-risk patients died, and their readmission rate was not significantly higher than in non-low-risk individuals. Importantly, none of the complications that prompted readmissions occurred in the more usual five-day period of hospital stay. The ZRS showed excellent discriminative ability and good fit in our population, suggesting that it could be used to guide early discharge in appropriately selected low-risk patients.Over recent decades, prognosis after STEMI has improved, owing mainly to the development of modern reperfusion modalities and antithrombotic drugs. Notably, LOS has also seen a progressive reduction, without an impact on mortality.<a class="elsevierStyleCrossRefs" href="#bib0140">9–11</a> This observation is particularly true for primary reperfusion in MI. Recent STEMI guidelines have stated, although with a low level of recommendation (IIB, level of evidence B), that risk score assessment tools such as the Prognosis Assessment in Myocardial Infarction (PAMI) score or the ZRS can be used to assess the risk for early discharge (within approximately 72 hours) and that this strategy is reasonable in selected low-risk patients, if early rehabilitation and appropriate follow-up are arranged. Historically, LOS after acute MI has evolved from an era of prolonged bed rest and rehabilitation of over six weeks to the present LOS of less than one week.<a class="elsevierStyleCrossRef" href="#bib0145">10</a> The typical LOS in the USA is five days in uncomplicated MI.<a class="elsevierStyleCrossRef" href="#bib0155">12</a> A number of studies have shown that a shorter LOS in acute MI, especially in the PPCI era, has not increased early cardiovascular mortality, recurrent ischemia or unplanned readmission due to heart failure.<a class="elsevierStyleCrossRefs" href="#bib0150">11–14</a> This study strengthens that notion, suggesting that in a large-volume PPCI center, there is a significant proportion (62.6%) of patients admitted for percutaneous revascularization deemed to have a low mortality risk.The rationale supporting an early discharge relates to the majority of life-threatening complications occurring in the first 72 hours.<a class="elsevierStyleCrossRef" href="#bib0125">6</a> Secondary malignant ventricular arrhythmias, mechanical complications and pump failure associated with extensive areas of myocardial necrosis usually occur in this time window, providing support for such a strategy. Topol et al. were among the first to demonstrate the safety of an early discharge policy, in 179 patients with uncomplicated MI (no angina, heart failure, or arrhythmia 72 hours after admission).<a class="elsevierStyleCrossRef" href="#bib0170">15</a> In another study, Newby et al. used a mixed-exponential survival model (an acute curve for most adverse events and a chronic curve describing a lower background rate) to show that up to 97% of complications (death, stroke, shock, congestive heart failure, reinfarction or ischemia) occur within 72 hours of admission for acute myocardial infarction (MI).<a class="elsevierStyleCrossRef" href="#bib0125">6</a> Moreover, the authors concluded that hospitalization of patients with uncomplicated MI beyond three days after thrombolysis was economically unattractive by conventional standards.The second question we aimed to answer pertains to the reasons behind increased LOS in this low-risk population. Fifty-two patients (30.4% of the low-risk cohort) were not discharged early, based on either a contraindication (18.7%) or a scheduled intervention (i.e. additional revascularization, 11.7%). These results are in agreement with the 16.1% of patients with contraindication to early discharge found in the study by De Luca et al.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> The decision to proceed with revascularization during the index admission (whether surgical or percutaneous) was tailored to each individual's case, taking into account the severity of angiographic lesions, myocardial area at risk and perceived risk-benefit relationship, as assessed by the medical team. Recently, the PRAMI trial suggested that non-culprit vessel revascularization during PPCI could be beneficial. If confirmed in larger trials and widely adopted, this strategy could indirectly help to reduce overall LOS.<a class="elsevierStyleCrossRef" href="#bib0175">16</a> Our data also support the notion that LOS is driven to some extent by non-clinical factors and that there is room for improvement. Other logistical and institutional factors, such as weekends and days with less medical staff (e.g. due to other activities such as teaching) have previously been identified as reasons for a prolonged LOS.<a class="elsevierStyleCrossRef" href="#bib0180">17</a>Some authors have raised concerns about early discharge after STEMI.<a class="elsevierStyleCrossRefs" href="#bib0105">2,18,19</a> The potential disadvantages of this strategy include less time for patient education (e.g. smoking cessation), drug titration and cardiac rehabilitation.<a class="elsevierStyleCrossRef" href="#bib0180">17</a> Notwithstanding these concerns, a study by Kotowycz et al. showed that drug adherence and smoking cessation rates among acute MI patients who were discharged early did not differ between those allocated to close post-discharge follow-up compared to those undergoing normal follow-up.<a class="elsevierStyleCrossRef" href="#bib0110">3</a> Regardless of policy, the use of risk assessment scores should never replace careful clinical evaluation, for which echocardiographic and angiographic data provide essential information.Several limitations of this study should be acknowledged. Firstly, this was a single-center, retrospective analysis, subject to inherent selection biases and sample size-related statistical limitations. Secondly, variables known to influence the prognosis of STEMI patients, such as time from symptom onset to first medical contact, admission brain natriuretic peptide or ST-segment resolution, were unavailable in a significant proportion of patients and were thus not included. Thirdly, this study does not address cost-effectiveness issues. Further studies are warranted to assess the economic impact of adopting a ZRS-guided early discharge policy.ConclusionsIn our population, the ZRS showed excellent discriminative capability to identify low-risk STEMI patients who could be safely discharged within 72 hours of PPCI. Further strategies are needed to optimize LOS in low-risk patients without a contraindication for early discharge.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that no patient data appear in this article.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres551430" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec568828" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres551429" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objectivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec568827" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient characteristics" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Hospital mortality and Zwolle risk score analysis" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Length of stay" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-02" "fechaAceptado" => "2015-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec568828" "palabras" => array:4 [ 0 => "ST-segment elevation myocardial infarction" 1 => "Primary percutaneous coronary intervention" 2 => "Zwolle risk score" 3 => "Early discharge" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec568827" "palabras" => array:4 [ 0 => "Enfarte agudo do miocárdio com supradesnivelamento de ST" 1 => "Intervenção coronária percutânea primária" 2 => "Score de Zwolle" 3 => "Alta precoce" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and AimThe optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population. MethodsWe studied 276 consecutive patients (mean age 62±14 years, 75% male, 20% Killip class >1) admitted over a two-year period for STEMI and treated with PPCI. ZRS, length of stay, 30-day mortality and readmission were obtained for all patients. Low risk was defined as ZRS ≤3. ResultsThe median ZRS was 3 (interquartile range [IQR] 1–4), with 171 patients (62%) being classified as low risk. Thirty-day mortality was 4.7% (13 patients). Compared to other patients, low-risk patients had shorter length of stay (median 5.0 [IQR 4–7] vs. 7.0 [5–13] days, p<0.001), and lower 30-day mortality (0 vs. 12.4%, p<0.001), yielding a negative predictive value of 100% (95% CI 97.0–100%) for the proposed cutoff. The ZRS showed excellent discriminative power (C-statistic: 0.937, 95% CI 0.906–0.968, p<0.001), and good calibration against the original cohort. ConclusionsThe ZRS appears to perform well in identifying low-risk STEMI patients who could be safely discharged within 72 hours of admission. Using the ZRS in our population could result in a more rational use of in-patient resources." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "Introdução e objectivosA duração ótima de internamento após enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST) não complicado, submetido a intervenção coronária percutânea primária (ICPP), permanece por determinar. O Score de Zwolle (SZ) é um instrumento simples, desenhado para identificar os doentes candidatos a alta precoce (<72h) segura. Este estudo pretendeu avaliar a aplicabilidade do SZ na nossa população. MétodosAnalisámos 276 doentes consecutivos (idade média 62±14 anos, 75% homens, 20% em classe de Killip>1) com EAMCST submetidos a ICPP durante um período de dois anos. Foram obtidos os SZ, duração de internamento, mortalidade e readmissão aos 30 dias. Foi definido baixo risco como SZ ≤3. ResultadosA mediana do SZ foi de 3 [distância interquartil (IQR) 1-4] e 171 doentes (62%) foram classificados como de baixo risco. A mortalidade aos 30 dias foi de 4,7% (13 doentes). Em comparação com os restantes, os doentes de baixo risco tiveram menor duração de internamento [mediana 5,0 (IQR 4-7) versus 7,0 (IQR 5-13) dias, p<0,001] e menor mortalidade (0 versus 12,4%, p<0,001), resultando num valor preditivo negativo de 100% (IC95% 97,0-100%) para o cut-off proposto. O ZS mostrou excelente poder descriminativo (estatística-C: 0,937, IC95% 0,906-0,968, p<0,001) e boa calibração quando comparado com o coorte original. ConclusõesO SZ parece capaz de identificar com precisão os doentes com EAMCST de baixo risco que podem ter alta segura 72h após a admissão. O uso do SZ na nossa população poderá resultar numa utilização mais racional dos recursos hospitalares." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objectivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>" "etiqueta" => "Appendix 1" "titulo" => "Zwolle risk score variables" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 1514 "Tamanyo" => 50731 ] ] "descripcion" => array:1 [ "en" => "Overall distribution of Zwolle risk score. ZRS: Zwolle risk score." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1335 "Ancho" => 1341 "Tamanyo" => 57534 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic curve for Zwolle risk score and 30-day mortality (C-statistic=0.937 [95% confidence interval 0.906–0.968, p<0.001])." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1309 "Ancho" => 1575 "Tamanyo" => 88808 ] ] "descripcion" => array:1 [ "en" => "Observed vs. expected 30-day mortality. Vertical bars show 95% confidence interval." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1531 "Ancho" => 2379 "Tamanyo" => 123107 ] ] "descripcion" => array:1 [ "en" => "Survival curves stratified by Zwolle risk score showing 95% confidence intervals. ZRS: Zwolle risk score." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1047 "Ancho" => 1517 "Tamanyo" => 42842 ] ] "descripcion" => array:1 [ "en" => "Early patient discharge by Zwolle risk score." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1057 "Ancho" => 1586 "Tamanyo" => 82980 ] ] "descripcion" => array:1 [ "en" => "Causes for increased length of stay in the low-risk cohort. CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; TIA: transient ischemic attack." ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CABG: coronary artery bypass grafting; IQR: interquartile range; LOS: length of stay; LVEF: left ventricular ejection fraction; MI: myocardial infarction; PCI: percutaneous coronary intervention; SD: standard deviation; ZRS: Zwolle risk score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS ≤3 (n=171) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS >3 (n=105) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.0±33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.9±13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.8±11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">208 (75.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133 (77.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (72.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.387 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151 (54.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (47.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (67.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyslipidemia (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">121 (43.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (43.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (19.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (14.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (27.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking (current or past) (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">153 (55.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 (67.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (35.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous MI (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (14.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (19.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.074 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous PCI (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (17.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.139 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous CABG (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.158 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">GRACE score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (median, IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147 (130–170) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (129–63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155 (136–179) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.139 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ischemia time (median, IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 (2.9–7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 (2.5–6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 (3.9–9.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TIMI flow pre-angioplasty (median, IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.704 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Stent (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">240 (87.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">153 (89.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (82.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.141 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean no. of stents per patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.364 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Procedural success (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.129 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Peak troponin I, μg/l (median, IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (10–102) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (11–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (7–111) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.442 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVEF ± SD<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (%) before discharge (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.0 ± 9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.0 ± 8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.7 11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LOS in days (median, IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 (4–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.0 (5–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab889926.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "For in-hospital death." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Available in 221 patients." ] ] ] "descripcion" => array:1 [ "en" => "Population characteristics." ] ] 7 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "MI: myocardial infarction; ZRS: Zwolle risk score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS ≤3 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS >3 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Killip class</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">220 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="4" align="char" valign="middle"><0.001</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">TIMI flow post-reperfusion</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">255 (92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="char" valign="middle"><0.001</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">0–1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age ≥60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Three-vessel disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anterior MI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ischemia time >4 hours \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">167 (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab889923.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of individual variables of the Zwolle risk score." ] ] 8 => array:7 [ "identificador" => "tbl0055" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "LOS: length of stay; ZRS: Zwolle risk score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LOS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">#1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subacute stent thrombosis (day 6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">#2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unstable angina (day 10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">#3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unstable angina (day 7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">#4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subacute stent thrombosis (day 13) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab889924.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patients readmitted in the 30 days following discharge." ] ] 9 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:2 [ "leyenda" => "TIMI: Thrombolysis In Myocardial Infarction angiographic score; MI: myocardial infarction." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Points \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Killip class</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">III–IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">TIMI flow post-reperfusion</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">0–1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Age</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Three-vessel disease</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Anterior MI</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Ischemia time >4 hours</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab889925.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.T. O’Gara" 1 => "F.G. Kushner" 2 => "D.D. Ascheim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e3182742cf6" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "127" "paginaInicial" => "e362" "paginaFinal" => "e425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23247304" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.G. Steg" 1 => "S.K. James" 2 => "D. Atar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehs215" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "2569" "paginaFinal" => "2619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922416" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction – a prospective and randomized trial in low-risk primary percutaneous coronary intervention patients (the Safe-Depart Trial)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.A. Kotowycz" 1 => "T.L. Cosman" 2 => "C. Tartaglia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2009.12.037" "Revista" => array:4 [ "tituloSerie" => "Am Heart J" "fecha" => "2010" "volumen" => "159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20362718" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0115" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identifying patient risk: the basis for rational discharge planning after acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.K. Newby" 1 => "R.M. Califf" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thromb Thrombolysis" "fecha" => "1996" "volumen" => "3" "paginaInicial" => "107" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10602551" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0120" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.L. Grines" 1 => "D.L. Marsalese" 2 => "B. Brodie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1998" "volumen" => "31" "paginaInicial" => "967" "paginaFinal" => "972" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9561995" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0125" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.K. Newby" 1 => "V. Hasselblad" 2 => "P.W. Armstrong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "182" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12573275" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. De Luca" 1 => "H. Suryapranata" 2 => "A.W. van’t Hof" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000131765.73959.87" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "109" "paginaInicial" => "2737" "paginaFinal" => "2743" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15159293" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0135" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting clinical states in individual patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.E. Braitman" 1 => "F. Davidoff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1996" "volumen" => "125" "paginaInicial" => "406" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8702092" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Declining length of hospital stay for acute myocardial infarction and postdischarge outcomes: a community-wide perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.A. Spencer" 1 => "D. Lessard" 2 => "J.M. Gore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.164.7.733" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2004" "volumen" => "164" "paginaInicial" => "733" "paginaFinal" => "740" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15078642" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Declining length of stay for patients hospitalized with AMI: impact on mortality and readmissions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Saczynski" 1 => "D. Lessard" 2 => "F.A. Spencer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2010.05.018" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2010" "volumen" => "123" "paginaInicial" => "1007" "paginaFinal" => "1015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21035590" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0150" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.A. Jones" 1 => "K.S. Rathod" 2 => "J.P. Howard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Heart (Br Card Soc)" "fecha" => "2012" "volumen" => "98" "paginaInicial" => "1722" "paginaFinal" => "1727" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0155" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Puymirat" 1 => "T. Simon" 2 => "P.G. Steg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/2012.jama.11348" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "308" "paginaInicial" => "998" "paginaFinal" => "1006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22928184" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0160" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early discharge after primary percutaneous coronary intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.J. Laarman" 1 => "M.T. Dirksen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Heart (Br Card Soc)" "fecha" => "2010" "volumen" => "96" "paginaInicial" => "584" "paginaFinal" => "587" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0165" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Noman" 1 => "A.G. Zaman" 2 => "C. Schechter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J: Acute Cardiovasc Care" "fecha" => "2013" "volumen" => "2" "paginaInicial" => "262" "paginaFinal" => "269" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0170" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.J. Topol" 1 => "K. Burek" 2 => "W.W. O’Neill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198804283181702" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1988" "volumen" => "318" "paginaInicial" => "1083" "paginaFinal" => "1088" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3281014" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0175" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized trial of preventive angioplasty in myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.S. Wald" 1 => "J.K. Morris" 2 => "N.J. Wald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1305520" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "369" "paginaInicial" => "1115" "paginaFinal" => "1123" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23991625" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0180" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.A. Kotowycz" 1 => "R.P. Syal" 2 => "R. Afzal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2009" "volumen" => "25" "paginaInicial" => "585" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19812804" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0185" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early discharge after acute myocardial infarction in the current clinical practice. Community data from the AMI-Florence Registry, Italy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Barchielli" 1 => "D. Balzi" 2 => "N. Marchionni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2006.01.006" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2007" "volumen" => "114" "paginaInicial" => "57" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16712984" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0190" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is the optimal length of stay in hospital for ST elevation myocardial infarction treated with primary percutaneous coronary intervention?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Karabulut" 1 => "M. Cakmak" 2 => "B. Uzunlar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cardiol J" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "378" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21769818" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003400000009/v1_201509110034/S0870255115001845/v1_201509110034/en/main.assets" "Apartado" => array:4 [ "identificador" => "29261" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artigos Originais" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003400000009/v1_201509110034/S0870255115001845/v1_201509110034/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001845?idApp=UINPBA00004E"]

Estatísticas

Original Article

Avaliação da segurança da alta precoce após enfarte agudo do miocárdio com supradesnivelamento do segmento ST submetido a intervenção coronária percutânea primária: o Score de Zwolle

António Tralhão

Autor para correspondência

atralhao@gmail.com

Corresponding author.

, António Miguel Ferreira, Sérgio Madeira, Miguel Borges Santos, Mariana Castro, Ingrid Rosário, Marisa Trabulo, Carlos Aguiar, Jorge Ferreira, Manuel Sousa Almeida, Miguel Mendes

Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal

Lido

8433

Vezes
que se leu este artigo

1981

Total PDF

6452

Total HTML

Compartilhar estatísticas

 array:26 [
  "pii" => "S0870255115001845"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2015.04.006"
  "estado" => "S300"
  "fechaPublicacion" => "2015-09-01"
  "aid" => "671"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2015;34:535-41"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4001
    "formatos" => array:3 [
      "EPUB" => 202
      "HTML" => 3141
      "PDF" => 658
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204915001853"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2015.08.005"
      "estado" => "S300"
      "fechaPublicacion" => "2015-09-01"
      "aid" => "671"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2015;34:535-41"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2942
        "formatos" => array:3 [
          "EPUB" => 179
          "HTML" => 2182
          "PDF" => 581
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "535"
            "paginaFinal" => "541"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Avalia&#231;&#227;o da seguran&#231;a da alta precoce ap&#243;s enfarte agudo do mioc&#225;rdio com supradesnivelamento do segmento ST submetido a interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria&#58; o <span class="elsevierStyleItalic">Score</span> de Zwolle"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0020"
            "etiqueta" => "Figure 4"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr4.jpeg"
                "Alto" => 1567
                "Ancho" => 2468
                "Tamanyo" => 179685
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Survival curves stratified by Zwolle risk score showing 95&#37; confidence intervals&#46; ZRS&#58; Zwolle risk score&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ant&#243;nio Tralh&#227;o, Ant&#243;nio Miguel Ferreira, S&#233;rgio Madeira, Miguel Borges Santos, Mariana Castro, Ingrid Ros&#225;rio, Marisa Trabulo, Carlos Aguiar, Jorge Ferreira, Manuel Sousa Almeida, Miguel Mendes"
            "autores" => array:11 [
              0 => array:2 [
                "nombre" => "Ant&#243;nio"
                "apellidos" => "Tralh&#227;o"
              ]
              1 => array:2 [
                "nombre" => "Ant&#243;nio Miguel"
                "apellidos" => "Ferreira"
              ]
              2 => array:2 [
                "nombre" => "S&#233;rgio"
                "apellidos" => "Madeira"
              ]
              3 => array:2 [
                "nombre" => "Miguel"
                "apellidos" => "Borges Santos"
              ]
              4 => array:2 [
                "nombre" => "Mariana"
                "apellidos" => "Castro"
              ]
              5 => array:2 [
                "nombre" => "Ingrid"
                "apellidos" => "Ros&#225;rio"
              ]
              6 => array:2 [
                "nombre" => "Marisa"
                "apellidos" => "Trabulo"
              ]
              7 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "Aguiar"
              ]
              8 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Ferreira"
              ]
              9 => array:2 [
                "nombre" => "Manuel Sousa"
                "apellidos" => "Almeida"
              ]
              10 => array:2 [
                "nombre" => "Miguel"
                "apellidos" => "Mendes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255115001845"
          "doi" => "10.1016/j.repc.2015.04.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001845?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001853?idApp=UINPBA00004E"
      "url" => "/21742049/0000003400000009/v1_201509130054/S2174204915001853/v1_201509130054/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255115001821"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.03.009"
    "estado" => "S300"
    "fechaPublicacion" => "2015-09-01"
    "aid" => "669"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2015;34:543-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3549
      "formatos" => array:3 [
        "EPUB" => 188
        "HTML" => 2698
        "PDF" => 663
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Autonomic activity and biomarker behavior in supine position and after passive postural stress in different orthostatic intolerance syndromes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "543"
          "paginaFinal" => "549"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Atividade auton&#243;mica e neurohormonal em doentes com intoler&#226;ncia ortost&#225;tica durante o supino e ap&#243;s ortostatismo passivo"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jo&#227;o Freitas, Elsa Azevedo, Rosa Santos, Maria J&#250;lia Maciel, Francisco Rocha-Gon&#231;alves"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Freitas"
            ]
            1 => array:2 [
              "nombre" => "Elsa"
              "apellidos" => "Azevedo"
            ]
            2 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Santos"
            ]
            3 => array:2 [
              "nombre" => "Maria J&#250;lia"
              "apellidos" => "Maciel"
            ]
            4 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Rocha-Gon&#231;alves"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204915001865"
        "doi" => "10.1016/j.repce.2015.08.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001865?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001821?idApp=UINPBA00004E"
    "url" => "/08702551/0000003400000009/v1_201509110034/S0870255115001821/v1_201509110034/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255115001833"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.03.010"
    "estado" => "S300"
    "fechaPublicacion" => "2015-09-01"
    "aid" => "670"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2015;34:529-33"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3360
      "formatos" => array:3 [
        "EPUB" => 180
        "HTML" => 2550
        "PDF" => 630
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Permanent pacemaker implantation after aortic valve replacement&#58; Long-term dependency or rhythm recovery&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "529"
          "paginaFinal" => "533"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> permanente ap&#243;s substitui&#231;&#227;o da v&#225;lvula a&#243;rtica&#58; depend&#234;ncia a longo prazo ou recupera&#231;&#227;o de ritmo&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#226;nia Ribeiro, Raquel Mota Garcia, Cec&#237;lia Frutuoso, Filipa Mel&#227;o, Marta Pereira, Paulo Pinho, Maria J&#250;lia Maciel"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "V&#226;nia"
              "apellidos" => "Ribeiro"
            ]
            1 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Mota Garcia"
            ]
            2 => array:2 [
              "nombre" => "Cec&#237;lia"
              "apellidos" => "Frutuoso"
            ]
            3 => array:2 [
              "nombre" => "Filipa"
              "apellidos" => "Mel&#227;o"
            ]
            4 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Pereira"
            ]
            5 => array:2 [
              "nombre" => "Paulo"
              "apellidos" => "Pinho"
            ]
            6 => array:2 [
              "nombre" => "Maria J&#250;lia"
              "apellidos" => "Maciel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204915001841"
        "doi" => "10.1016/j.repce.2015.08.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001841?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001833?idApp=UINPBA00004E"
    "url" => "/08702551/0000003400000009/v1_201509110034/S0870255115001833/v1_201509110034/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "pii" => "S0870255116303468"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2016.07.006"
      "estado" => "S300"
      "fechaPublicacion" => "2017-01-01"
      "aid" => "919"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "cor"
      "cita" => "Rev Port Cardiol. 2017;36:71"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2100
        "formatos" => array:3 [
          "EPUB" => 213
          "HTML" => 1476
          "PDF" => 411
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "Determinants of safety of early discharge after primary percutaneous coronary intervention"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "71"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Determinantes de seguran&#231;a na alta antecipada ap&#243;s interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Levent Cerit"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Levent"
                "apellidos" => "Cerit"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204916302793"
          "doi" => "10.1016/j.repce.2016.12.014"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302793?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303468?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000001/v2_201701040047/S0870255116303468/v2_201701040047/en/main.assets"
    ]
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "535"
        "paginaFinal" => "541"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Ant&#243;nio Tralh&#227;o, Ant&#243;nio Miguel Ferreira, S&#233;rgio Madeira, Miguel Borges Santos, Mariana Castro, Ingrid Ros&#225;rio, Marisa Trabulo, Carlos Aguiar, Jorge Ferreira, Manuel Sousa Almeida, Miguel Mendes"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "Ant&#243;nio"
            "apellidos" => "Tralh&#227;o"
            "email" => array:1 [
              0 => "atralhao&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Ant&#243;nio Miguel"
            "apellidos" => "Ferreira"
          ]
          2 => array:2 [
            "nombre" => "S&#233;rgio"
            "apellidos" => "Madeira"
          ]
          3 => array:2 [
            "nombre" => "Miguel"
            "apellidos" => "Borges Santos"
          ]
          4 => array:2 [
            "nombre" => "Mariana"
            "apellidos" => "Castro"
          ]
          5 => array:2 [
            "nombre" => "Ingrid"
            "apellidos" => "Ros&#225;rio"
          ]
          6 => array:2 [
            "nombre" => "Marisa"
            "apellidos" => "Trabulo"
          ]
          7 => array:2 [
            "nombre" => "Carlos"
            "apellidos" => "Aguiar"
          ]
          8 => array:2 [
            "nombre" => "Jorge"
            "apellidos" => "Ferreira"
          ]
          9 => array:2 [
            "nombre" => "Manuel Sousa"
            "apellidos" => "Almeida"
          ]
          10 => array:2 [
            "nombre" => "Miguel"
            "apellidos" => "Mendes"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Hospital de Santa Cruz&#44; Western Lisbon Hospital Centre&#44; Department of Cardiology&#44; Carnaxide&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Avalia&#231;&#227;o da seguran&#231;a da alta precoce ap&#243;s enfarte agudo do mioc&#225;rdio com supradesnivelamento do segmento ST submetido a interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria&#58; o <span class="elsevierStyleItalic">Score</span> de Zwolle"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1531
            "Ancho" => 2379
            "Tamanyo" => 123107
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Survival curves stratified by Zwolle risk score showing 95&#37; confidence intervals&#46; ZRS&#58; Zwolle risk score&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">ST-segment elevation myocardial infarction &#40;STEMI&#41; is one the most frequent presentations of acute coronary syndromes&#46; Despite significant reductions in morbidity and mortality due to optimization of reperfusion strategies&#44; some issues are still poorly defined in the current guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;2</span></a> One of the least studied aspects is the optimal length of stay &#40;LOS&#41; for patients with uncomplicated STEMI&#46; Current practice adopts 5&#8211;7 days for monitoring of complications&#44; but this is largely empirical&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;4</span></a> A need to better define the appropriate LOS has been recognized by European and American cardiovascular societies&#44; which suggest the use of prognostic tools to accurately identify low-risk patients who can be safely discharged within 72 hours&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;6</span></a> The Zwolle risk score &#40;ZRS&#41; is a simple six-item score &#40;age &#8805;60&#44; time to reperfusion &#62;4 hours&#44; anterior infarct&#44; TIMI flow post angioplasty&#44; three-vessel disease&#44; Killip class&#59; <a class="elsevierStyleCrossRef" href="#sec0075">Appendix 1</a>&#41; that showed promising results in a pivotal study&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> Using the ZRS could potentially improve patient throughput and reduce healthcare costs&#44;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;7</span></a> but any failure to identify patients who will suffer from early complications could have dire consequences and legal implications&#46; The adoption of a targeted early discharge policy should therefore always be preceded by validation in the specific population in which it will be used&#46; We sought to validate the ZRS in our population of STEMI patients and to identify variables associated with increased LOS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted an observational retrospective study of all patients with STEMI referred to our center for primary percutaneous coronary intervention &#40;PPCI&#41; between January 2011 and December 2012 &#40;n&#61;278&#41;&#46; Of these&#44; two died during the index procedure and were excluded from the analysis&#44; yielding a population of 276 patients admitted to the cardiac intensive care unit&#46; The ZRS was calculated for each patient&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> In this score&#44; each variable is given points for a minimum score of 0 and a maximum of 16 &#40;<a class="elsevierStyleCrossRef" href="#sec0075">Appendix 1</a>&#41;&#46; Low risk was defined as ZRS &#8804;3&#44; as in the original study&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> In the subset of low-risk patients&#44; clinical data were additionally scanned for variables that could influence LOS&#46; LOS was defined as the time &#40;in days&#41; from first balloon inflation to time of hospital discharge&#46; The primary endpoint was 30-day mortality&#46; The secondary endpoint was death or readmission within 30 days of discharge&#46; Mortality and readmissions up to 30 days after discharge were obtained for all patients by reviewing medical charts&#44; supplemented by telephone interview whenever necessary&#46; Informed consent for inclusion in a prospective registry was obtained from all patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using SPSS version 21&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41; and MedCalc 6&#46;0 &#40;MedCalc Software&#44; Ostend&#44; Belgium&#41;&#46; Differences between groups were tested using the t test and one-way analysis of variance and the K test for medians for continuous variables with a normal and non-normal distribution&#44; respectively&#46; Categorical variables were compared using Fisher&#39;s exact test&#46; The log-rank test was used for survival analysis&#46; The clinical usefulness of any predictive score or model relies on its goodness-of-fit and discriminative ability&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> The goodness-of-fit of the ZRS&#44; reflecting how close the predicted 30-day mortality is to that observed&#44; was assessed by a calibration plot and by the calibration-in-the-large statistic&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> The discriminative ability of the ZRS in our population &#40;i&#46;e&#46;&#44; the extent to which the score is able to separate survivors from non-survivors&#41; was expressed by the C-statistic&#44; which&#44; for binary outcomes&#44; is equal to the area under the receiver operating characteristic &#40;ROC&#41; curve&#46; Two-tailed p values &#60;0&#46;05 were considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient characteristics</span><p id="par0020" class="elsevierStylePara elsevierViewall">Patient characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>&#46; The median ZRS was 3 &#40;interquartile range &#91;IQR&#93; 1&#8211;4&#41;&#44; with 171 patients &#40;62&#37;&#41; being classified as low-risk &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Compared to other patients&#44; low-risk patients were younger and had a lower prevalence of hypertension and diabetes and a higher proportion of smokers&#46; The frequency of each component of the ZRS is depicted in <a class="elsevierStyleCrossRef" href="#tbl0035">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hospital mortality and Zwolle risk score analysis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Thirty-day mortality occurred in 13 patients &#40;4&#46;7&#37;&#41;&#46; ROC curve analysis yielded a C-statistic of 0&#46;937 &#40;95&#37; CI 0&#46;906&#8211;0&#46;968&#44; p&#60;0&#46;001&#41;&#44; demonstrating excellent discriminative power &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Calibration-in-the-large was performed using the observed mortality rate of the original study<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> compared against this validation cohort&#44; divided into four subgroups &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#44; yielding a value of 10&#46;1&#37;&#44; due to a higher mortality rate in the original cohort&#46; Overall&#44; the observed mortality was similar to that predicted by the ZRS&#44; although the latter tended to overestimate the likelihood of fatal events in patients with higher scores&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">When stratified using a cut-off ZRS of 3&#44; a significant difference was found in 30-day survival between patients classified as ZRS &#8804;3 and ZRS &#62;3 &#40;100 vs&#46; 87&#46;6&#37;&#44; log-rank p&#60;0&#46;0001&#59; <a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#44; yielding a negative predictive value of 100&#37; &#40;95&#37; CI 97&#8211;100&#37;&#41; for 30-day mortality&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Length of stay</span><p id="par0040" class="elsevierStylePara elsevierViewall">Median LOS was 5 &#40;IQR 4&#8211;9&#41; days&#46; Median LOS in the low-risk group was significantly lower &#40;5&#46;0 &#91;IQR 4&#8211;7&#93; vs&#46; 7&#46;0 &#91;IQR 5&#8211;13&#93; days&#44; p&#60;0&#46;001&#41;&#44; with 22&#37; of patients being discharged within 72 hours in the low-risk group vs&#46; 14&#37; in the non-low-risk group &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>&#41;&#46; In the 171 low-risk patients&#44; 38 were discharged in &#8804;72 hours after the index event&#46; Among the other 133 individuals&#44; 52 had some contraindication for an earlier discharge &#40;e&#46;g&#46; left ventricular thrombus&#44; atrial fibrillation&#44; or bleeding complication&#41;&#46; Additional staged revascularization &#40;either percutaneous or surgical&#41; was the most frequent cause for a lengthened stay in this low-risk population&#46; Seven patients also underwent additional ischemia testing&#46; In this low-risk cohort&#44; 81 patients had no discernible medical reason for an increased LOS&#46; These patients represented 221 extra days of stay beyond 72 hours &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Figure 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">No deaths occurred in the 30 days following discharge&#46; Four &#40;1&#46;4&#37;&#41; patients were readmitted in this period &#40;<a class="elsevierStyleCrossRef" href="#tbl0055">Table 3</a>&#41;&#44; three in the ZRS &#8804;3 group and one in the ZRS &#62;3 group &#40;p&#61;1&#46;0&#41;&#46;</p><elsevierMultimedia ident="tbl0055"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">In the absence of formal recommendations on the ideal LOS after uncomplicated STEMI&#44; decisions regarding the time of discharge are usually made on an individual basis&#44; considering the patient&#39;s previous comorbidities and immediate clinical course following MI&#46; Our study shows that&#44; in a population of real-world consecutive STEMI patients treated with PPCI&#44; a strategy of early discharge &#40;&#8804;72 hours&#41; guided by the ZRS is feasible and safe in selected low-risk patients&#46; None of these low-risk patients died&#44; and their readmission rate was not significantly higher than in non-low-risk individuals&#46; Importantly&#44; none of the complications that prompted readmissions occurred in the more usual five-day period of hospital stay&#46; The ZRS showed excellent discriminative ability and good fit in our population&#44; suggesting that it could be used to guide early discharge in appropriately selected low-risk patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Over recent decades&#44; prognosis after STEMI has improved&#44; owing mainly to the development of modern reperfusion modalities and antithrombotic drugs&#46; Notably&#44; LOS has also seen a progressive reduction&#44; without an impact on mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#8211;11</span></a> This observation is particularly true for primary reperfusion in MI&#46; Recent STEMI guidelines have stated&#44; although with a low level of recommendation &#40;IIB&#44; level of evidence B&#41;&#44; that risk score assessment tools such as the Prognosis Assessment in Myocardial Infarction &#40;PAMI&#41; score or the ZRS can be used to assess the risk for early discharge &#40;within approximately 72 hours&#41; and that this strategy is reasonable in selected low-risk patients&#44; if early rehabilitation and appropriate follow-up are arranged&#46; Historically&#44; LOS after acute MI has evolved from an era of prolonged bed rest and rehabilitation of over six weeks to the present LOS of less than one week&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> The typical LOS in the USA is five days in uncomplicated MI&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> A number of studies have shown that a shorter LOS in acute MI&#44; especially in the PPCI era&#44; has not increased early cardiovascular mortality&#44; recurrent ischemia or unplanned readmission due to heart failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;14</span></a> This study strengthens that notion&#44; suggesting that in a large-volume PPCI center&#44; there is a significant proportion &#40;62&#46;6&#37;&#41; of patients admitted for percutaneous revascularization deemed to have a low mortality risk&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The rationale supporting an early discharge relates to the majority of life-threatening complications occurring in the first 72 hours&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Secondary malignant ventricular arrhythmias&#44; mechanical complications and pump failure associated with extensive areas of myocardial necrosis usually occur in this time window&#44; providing support for such a strategy&#46; Topol et al&#46; were among the first to demonstrate the safety of an early discharge policy&#44; in 179 patients with uncomplicated MI &#40;no angina&#44; heart failure&#44; or arrhythmia 72 hours after admission&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> In another study&#44; Newby et al&#46; used a mixed-exponential survival model &#40;an acute curve for most adverse events and a chronic curve describing a lower background rate&#41; to show that up to 97&#37; of complications &#40;death&#44; stroke&#44; shock&#44; congestive heart failure&#44; reinfarction or ischemia&#41; occur within 72 hours of admission for acute myocardial infarction &#40;MI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Moreover&#44; the authors concluded that hospitalization of patients with uncomplicated MI beyond three days after thrombolysis was economically unattractive by conventional standards&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The second question we aimed to answer pertains to the reasons behind increased LOS in this low-risk population&#46; Fifty-two patients &#40;30&#46;4&#37; of the low-risk cohort&#41; were not discharged early&#44; based on either a contraindication &#40;18&#46;7&#37;&#41; or a scheduled intervention &#40;i&#46;e&#46; additional revascularization&#44; 11&#46;7&#37;&#41;&#46; These results are in agreement with the 16&#46;1&#37; of patients with contraindication to early discharge found in the study by De Luca et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> The decision to proceed with revascularization during the index admission &#40;whether surgical or percutaneous&#41; was tailored to each individual&#39;s case&#44; taking into account the severity of angiographic lesions&#44; myocardial area at risk and perceived risk-benefit relationship&#44; as assessed by the medical team&#46; Recently&#44; the PRAMI trial suggested that non-culprit vessel revascularization during PPCI could be beneficial&#46; If confirmed in larger trials and widely adopted&#44; this strategy could indirectly help to reduce overall LOS&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> Our data also support the notion that LOS is driven to some extent by non-clinical factors and that there is room for improvement&#46; Other logistical and institutional factors&#44; such as weekends and days with less medical staff &#40;e&#46;g&#46; due to other activities such as teaching&#41; have previously been identified as reasons for a prolonged LOS&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Some authors have raised concerns about early discharge after STEMI&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;18&#44;19</span></a> The potential disadvantages of this strategy include less time for patient education &#40;e&#46;g&#46; smoking cessation&#41;&#44; drug titration and cardiac rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Notwithstanding these concerns&#44; a study by Kotowycz et al&#46; showed that drug adherence and smoking cessation rates among acute MI patients who were discharged early did not differ between those allocated to close post-discharge follow-up compared to those undergoing normal follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Regardless of policy&#44; the use of risk assessment scores should never replace careful clinical evaluation&#44; for which echocardiographic and angiographic data provide essential information&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Several limitations of this study should be acknowledged&#46; Firstly&#44; this was a single-center&#44; retrospective analysis&#44; subject to inherent selection biases and sample size-related statistical limitations&#46; Secondly&#44; variables known to influence the prognosis of STEMI patients&#44; such as time from symptom onset to first medical contact&#44; admission brain natriuretic peptide or ST-segment resolution&#44; were unavailable in a significant proportion of patients and were thus not included&#46; Thirdly&#44; this study does not address cost-effectiveness issues&#46; Further studies are warranted to assess the economic impact of adopting a ZRS-guided early discharge policy&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">In our population&#44; the ZRS showed excellent discriminative capability to identify low-risk STEMI patients who could be safely discharged within 72 hours of PPCI&#46; Further strategies are needed to optimize LOS in low-risk patients without a contraindication for early discharge&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres551430"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and Aim"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec568828"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres551429"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introdu&#231;&#227;o e objectivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#245;es"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec568827"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Patient characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Hospital mortality and Zwolle risk score analysis"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Length of stay"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conclusions"
        ]
        9 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-11-02"
    "fechaAceptado" => "2015-04-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec568828"
          "palabras" => array:4 [
            0 => "ST-segment elevation myocardial infarction"
            1 => "Primary percutaneous coronary intervention"
            2 => "Zwolle risk score"
            3 => "Early discharge"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec568827"
          "palabras" => array:4 [
            0 => "Enfarte agudo do mioc&#225;rdio com supradesnivelamento de ST"
            1 => "Interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria"
            2 => "<span class="elsevierStyleItalic">Score</span> de Zwolle"
            3 => "Alta precoce"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction &#40;STEMI&#41; treated with primary percutaneous coronary intervention &#40;PPCI&#41; is still undetermined&#46; The Zwolle risk score &#40;ZRS&#41; is a simple tool designed to identify patients who can be safely discharged within 72 hours&#46; The purpose of this study was to assess the applicability and performance of the ZRS in our population&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We studied 276 consecutive patients &#40;mean age 62&#177;14 years&#44; 75&#37; male&#44; 20&#37; Killip class &#62;1&#41; admitted over a two-year period for STEMI and treated with PPCI&#46; ZRS&#44; length of stay&#44; 30-day mortality and readmission were obtained for all patients&#46; Low risk was defined as ZRS &#8804;3&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The median ZRS was 3 &#40;interquartile range &#91;IQR&#93; 1&#8211;4&#41;&#44; with 171 patients &#40;62&#37;&#41; being classified as low risk&#46; Thirty-day mortality was 4&#46;7&#37; &#40;13 patients&#41;&#46; Compared to other patients&#44; low-risk patients had shorter length of stay &#40;median 5&#46;0 &#91;IQR 4&#8211;7&#93; vs&#46; 7&#46;0 &#91;5&#8211;13&#93; days&#44; p&#60;0&#46;001&#41;&#44; and lower 30-day mortality &#40;0 vs&#46; 12&#46;4&#37;&#44; p&#60;0&#46;001&#41;&#44; yielding a negative predictive value of 100&#37; &#40;95&#37; CI 97&#46;0&#8211;100&#37;&#41; for the proposed cutoff&#46; The ZRS showed excellent discriminative power &#40;C-statistic&#58; 0&#46;937&#44; 95&#37; CI 0&#46;906&#8211;0&#46;968&#44; p&#60;0&#46;001&#41;&#44; and good calibration against the original cohort&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The ZRS appears to perform well in identifying low-risk STEMI patients who could be safely discharged within 72 hours of admission&#46; Using the ZRS in our population could result in a more rational use of in-patient resources&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Aim"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objectivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A dura&#231;&#227;o &#243;tima de internamento ap&#243;s enfarte agudo do mioc&#225;rdio com supradesnivelamento do segmento ST &#40;EAMCST&#41; n&#227;o complicado&#44; submetido a interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria &#40;ICPP&#41;&#44; permanece por determinar&#46; O <span class="elsevierStyleItalic">Score</span> de Zwolle &#40;SZ&#41; &#233; um instrumento simples&#44; desenhado para identificar os doentes candidatos a alta precoce &#40;&#60;72h&#41; segura&#46; Este estudo pretendeu avaliar a aplicabilidade do SZ na nossa popula&#231;&#227;o&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analis&#225;mos 276 doentes consecutivos &#40;idade m&#233;dia 62&#177;14 anos&#44; 75&#37; homens&#44; 20&#37; em classe de Killip&#62;1&#41; com EAMCST submetidos a ICPP durante um per&#237;odo de dois anos&#46; Foram obtidos os SZ&#44; dura&#231;&#227;o de internamento&#44; mortalidade e readmiss&#227;o aos 30 dias&#46; Foi definido baixo risco como SZ &#8804;3&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A mediana do SZ foi de 3 &#91;dist&#226;ncia interquartil &#40;IQR&#41; 1-4&#93; e 171 doentes &#40;62&#37;&#41; foram classificados como de baixo risco&#46; A mortalidade aos 30 dias foi de 4&#44;7&#37; &#40;13 doentes&#41;&#46; Em compara&#231;&#227;o com os restantes&#44; os doentes de baixo risco tiveram menor dura&#231;&#227;o de internamento &#91;mediana 5&#44;0 &#40;IQR 4-7&#41; <span class="elsevierStyleItalic">versus</span> 7&#44;0 &#40;IQR 5-13&#41; dias&#44; p&#60;0&#44;001&#93; e menor mortalidade &#40;0 <span class="elsevierStyleItalic">versus</span> 12&#44;4&#37;&#44; p&#60;0&#44;001&#41;&#44; resultando num valor preditivo negativo de 100&#37; &#40;IC95&#37; 97&#44;0-100&#37;&#41; para o <span class="elsevierStyleItalic">cut-off</span> proposto&#46; O ZS mostrou excelente poder descriminativo &#40;estat&#237;stica-C&#58; 0&#44;937&#44; IC95&#37; 0&#44;906-0&#44;968&#44; p&#60;0&#44;001&#41; e boa calibra&#231;&#227;o quando comparado com o coorte original&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O SZ parece capaz de identificar com precis&#227;o os doentes com EAMCST de baixo risco que podem ter alta segura 72h ap&#243;s a admiss&#227;o&#46; O uso do SZ na nossa popula&#231;&#227;o poder&#225; resultar numa utiliza&#231;&#227;o mais racional dos recursos hospitalares&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objectivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0110" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix 1"
            "titulo" => "Zwolle risk score variables"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
    "multimedia" => array:10 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1201
            "Ancho" => 1514
            "Tamanyo" => 50731
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Overall distribution of Zwolle risk score&#46; ZRS&#58; Zwolle risk score&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1335
            "Ancho" => 1341
            "Tamanyo" => 57534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve for Zwolle risk score and 30-day mortality &#40;C-statistic&#61;0&#46;937 &#91;95&#37; confidence interval 0&#46;906&#8211;0&#46;968&#44; p&#60;0&#46;001&#93;&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1309
            "Ancho" => 1575
            "Tamanyo" => 88808
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Observed vs&#46; expected 30-day mortality&#46; Vertical bars show 95&#37; confidence interval&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1531
            "Ancho" => 2379
            "Tamanyo" => 123107
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Survival curves stratified by Zwolle risk score showing 95&#37; confidence intervals&#46; ZRS&#58; Zwolle risk score&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1047
            "Ancho" => 1517
            "Tamanyo" => 42842
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Early patient discharge by Zwolle risk score&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1057
            "Ancho" => 1586
            "Tamanyo" => 82980
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Causes for increased length of stay in the low-risk cohort&#46; CABG&#58; coronary artery bypass grafting&#59; PCI&#58; percutaneous coronary intervention&#59; TIA&#58; transient ischemic attack&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CABG&#58; coronary artery bypass grafting&#59; IQR&#58; interquartile range&#59; LOS&#58; length of stay&#59; LVEF&#58; left ventricular ejection fraction&#59; MI&#58; myocardial infarction&#59; PCI&#58; percutaneous coronary intervention&#59; SD&#58; standard deviation&#59; ZRS&#58; Zwolle risk score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS &#8804;3 &#40;n&#61;171&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS &#62;3 &#40;n&#61;105&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&#44; years &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;0&#177;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;9&#177;13&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;8&#177;11&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Male &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208 &#40;75&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133 &#40;77&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;72&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;387&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hypertension &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151 &#40;54&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;47&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;67&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dyslipidemia &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">121 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;43&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diabetes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;19&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Smoking &#40;current or past&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;55&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116 &#40;67&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;35&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Previous MI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;19&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Previous PCI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Previous CABG &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;158&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">GRACE score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147 &#40;130&#8211;170&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">144 &#40;129&#8211;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155 &#40;136&#8211;179&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ischemia time &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7 &#40;2&#46;9&#8211;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;0 &#40;2&#46;5&#8211;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3 &#40;3&#46;9&#8211;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">TIMI flow pre-angioplasty &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;704&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Stent &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240 &#40;87&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;89&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;82&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mean no&#46; of stents per patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Procedural success &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Peak troponin I&#44; &#956;g&#47;l &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;10&#8211;102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;11&#8211;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;7&#8211;111&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;442&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVEF &#177; SD<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;&#37;&#41; before discharge &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;0 &#177; 9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;0 &#177; 8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;7 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LOS in days &#40;median&#44; IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0 &#40;4&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0 &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0 &#40;5&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab889926.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">For in-hospital death&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Available in 221 patients&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Population characteristics&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0035"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">MI&#58; myocardial infarction&#59; ZRS&#58; Zwolle risk score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS &#8804;3 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS &#62;3 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Killip class</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">220 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="4" align="char" valign="middle">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">TIMI flow post-reperfusion</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">255 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="middle">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#8805;60 years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Three-vessel disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Anterior MI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ischemia time &#62;4 hours</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">167 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab889923.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Distribution of individual variables of the Zwolle risk score&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "tbl0055"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">LOS&#58; length of stay&#59; ZRS&#58; Zwolle risk score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ZRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LOS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#35;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subacute stent thrombosis &#40;day 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#35;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unstable angina &#40;day 10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#35;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unstable angina &#40;day 7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#35;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subacute stent thrombosis &#40;day 13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab889924.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Patients readmitted in the 30 days following discharge&#46;</p>"
        ]
      ]
      9 => array:5 [
        "identificador" => "tbl0005"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">TIMI&#58; Thrombolysis In Myocardial Infarction angiographic score&#59; MI&#58; myocardial infarction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Killip class</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&#8211;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">TIMI flow post-reperfusion</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Three-vessel disease</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Anterior MI</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Ischemia time &#62;4 hours</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab889925.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of ST-elevation myocardial infarction&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;T&#46; O&#8217;Gara"
                            1 => "F&#46;G&#46; Kushner"
                            2 => "D&#46;D&#46; Ascheim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e3182742cf6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "e362"
                        "paginaFinal" => "e425"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23247304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Steg"
                            1 => "S&#46;K&#46; James"
                            2 => "D&#46; Atar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs215"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2569"
                        "paginaFinal" => "2619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction &#8211; a prospective and randomized trial in low-risk primary percutaneous coronary intervention patients &#40;the Safe-Depart Trial&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Kotowycz"
                            1 => "T&#46;L&#46; Cosman"
                            2 => "C&#46; Tartaglia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2009.12.037"
                      "Revista" => array:4 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2010"
                        "volumen" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20362718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying patient risk&#58; the basis for rational discharge planning after acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;K&#46; Newby"
                            1 => "R&#46;M&#46; Califf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Thrombolysis"
                        "fecha" => "1996"
                        "volumen" => "3"
                        "paginaInicial" => "107"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10602551"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction&#46; PAMI-II Investigators&#46; Primary Angioplasty in Myocardial Infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;L&#46; Grines"
                            1 => "D&#46;L&#46; Marsalese"
                            2 => "B&#46; Brodie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1998"
                        "volumen" => "31"
                        "paginaInicial" => "967"
                        "paginaFinal" => "972"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9561995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time-based risk assessment after myocardial infarction&#46; Implications for timing of discharge and applications to medical decision-making"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;K&#46; Newby"
                            1 => "V&#46; Hasselblad"
                            2 => "P&#46;W&#46; Armstrong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "182"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12573275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty&#58; implications for early discharge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; De Luca"
                            1 => "H&#46; Suryapranata"
                            2 => "A&#46;W&#46; van&#8217;t Hof"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000131765.73959.87"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2004"
                        "volumen" => "109"
                        "paginaInicial" => "2737"
                        "paginaFinal" => "2743"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15159293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting clinical states in individual patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;E&#46; Braitman"
                            1 => "F&#46; Davidoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1996"
                        "volumen" => "125"
                        "paginaInicial" => "406"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8702092"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Declining length of hospital stay for acute myocardial infarction and postdischarge outcomes&#58; a community-wide perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46;A&#46; Spencer"
                            1 => "D&#46; Lessard"
                            2 => "J&#46;M&#46; Gore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinte.164.7.733"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2004"
                        "volumen" => "164"
                        "paginaInicial" => "733"
                        "paginaFinal" => "740"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15078642"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Declining length of stay for patients hospitalized with AMI&#58; impact on mortality and readmissions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Saczynski"
                            1 => "D&#46; Lessard"
                            2 => "F&#46;A&#46; Spencer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2010.05.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2010"
                        "volumen" => "123"
                        "paginaInicial" => "1007"
                        "paginaFinal" => "1015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21035590"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Jones"
                            1 => "K&#46;S&#46; Rathod"
                            2 => "J&#46;P&#46; Howard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Heart &#40;Br Card Soc&#41;"
                        "fecha" => "2012"
                        "volumen" => "98"
                        "paginaInicial" => "1722"
                        "paginaFinal" => "1727"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Puymirat"
                            1 => "T&#46; Simon"
                            2 => "P&#46;G&#46; Steg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/2012.jama.11348"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "308"
                        "paginaInicial" => "998"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22928184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early discharge after primary percutaneous coronary intervention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;J&#46; Laarman"
                            1 => "M&#46;T&#46; Dirksen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Heart &#40;Br Card Soc&#41;"
                        "fecha" => "2010"
                        "volumen" => "96"
                        "paginaInicial" => "584"
                        "paginaFinal" => "587"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Noman"
                            1 => "A&#46;G&#46; Zaman"
                            2 => "C&#46; Schechter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J&#58; Acute Cardiovasc Care"
                        "fecha" => "2013"
                        "volumen" => "2"
                        "paginaInicial" => "262"
                        "paginaFinal" => "269"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;J&#46; Topol"
                            1 => "K&#46; Burek"
                            2 => "W&#46;W&#46; O&#8217;Neill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198804283181702"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1988"
                        "volumen" => "318"
                        "paginaInicial" => "1083"
                        "paginaFinal" => "1088"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3281014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized trial of preventive angioplasty in myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;S&#46; Wald"
                            1 => "J&#46;K&#46; Morris"
                            2 => "N&#46;J&#46; Wald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1305520"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "1115"
                        "paginaFinal" => "1123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23991625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Kotowycz"
                            1 => "R&#46;P&#46; Syal"
                            2 => "R&#46; Afzal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "paginaInicial" => "585"
                        "paginaFinal" => "588"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19812804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early discharge after acute myocardial infarction in the current clinical practice&#46; Community data from the AMI-Florence Registry&#44; Italy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Barchielli"
                            1 => "D&#46; Balzi"
                            2 => "N&#46; Marchionni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2006.01.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2007"
                        "volumen" => "114"
                        "paginaInicial" => "57"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16712984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What is the optimal length of stay in hospital for ST elevation myocardial infarction treated with primary percutaneous coronary intervention&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Karabulut"
                            1 => "M&#46; Cakmak"
                            2 => "B&#46; Uzunlar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol J"
                        "fecha" => "2011"
                        "volumen" => "18"
                        "paginaInicial" => "378"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21769818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003400000009/v1_201509110034/S0870255115001845/v1_201509110034/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29261"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigos Originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003400000009/v1_201509110034/S0870255115001845/v1_201509110034/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001845?idApp=UINPBA00004E"
]

Informação do artigo

ISSN: 08702551
Idioma original: Inglês

DOI:10.1016/j.repc.2015.04.006

Dados atualizados diariamente

Ano/Mês	Html	Pdf	Total

2024 Novembro	9	6	15
2024 Outubro	53	24	77
2024 Setembro	538	35	573
2024 Agosto	72	30	102
2024 Julho	70	28	98
2024 Junho	60	25	85
2024 Maio	46	23	69
2024 Abril	60	26	86
2024 Mar�o	90	30	120
2024 Fevereiro	70	49	119
2024 Janeiro	50	37	87
2023 Dezembro	59	31	90
2023 Novembro	64	20	84
2023 Outubro	45	15	60
2023 Setembro	38	23	61
2023 Agosto	48	22	70
2023 Julho	36	15	51
2023 Junho	45	17	62
2023 Maio	48	27	75
2023 Abril	23	4	27
2023 Mar�o	89	29	118
2023 Fevereiro	51	19	70
2023 Janeiro	30	16	46
2022 Dezembro	52	36	88
2022 Novembro	64	18	82
2022 Outubro	53	17	70
2022 Setembro	36	25	61
2022 Agosto	34	18	52
2022 Julho	46	40	86
2022 Junho	32	22	54
2022 Maio	35	30	65
2022 Abril	48	29	77
2022 Mar�o	40	36	76
2022 Fevereiro	34	25	59
2022 Janeiro	40	26	66
2021 Dezembro	36	24	60
2021 Novembro	45	41	86
2021 Outubro	41	48	89
2021 Setembro	31	34	65
2021 Agosto	40	30	70
2021 Julho	39	26	65
2021 Junho	41	16	57
2021 Maio	44	30	74
2021 Abril	81	27	108
2021 Mar�o	71	15	86
2021 Fevereiro	74	16	90
2021 Janeiro	41	10	51
2020 Dezembro	32	14	46
2020 Novembro	49	20	69
2020 Outubro	20	8	28
2020 Setembro	71	13	84
2020 Agosto	34	7	41
2020 Julho	64	15	79
2020 Junho	51	12	63
2020 Maio	71	8	79
2020 Abril	49	21	70
2020 Mar�o	57	11	68
2020 Fevereiro	128	23	151
2020 Janeiro	44	7	51
2019 Dezembro	35	16	51
2019 Novembro	64	10	74
2019 Outubro	38	4	42
2019 Setembro	40	4	44
2019 Agosto	43	11	54
2019 Julho	46	8	54
2019 Junho	35	23	58
2019 Maio	66	10	76
2019 Abril	40	18	58
2019 Mar�o	43	14	57
2019 Fevereiro	53	13	66
2019 Janeiro	35	4	39
2018 Dezembro	64	13	77
2018 Novembro	122	7	129
2018 Outubro	253	20	273
2018 Setembro	67	13	80
2018 Agosto	34	13	47
2018 Julho	64	5	69
2018 Junho	72	4	76
2018 Maio	101	13	114
2018 Abril	47	14	61
2018 Mar�o	112	11	123
2018 Fevereiro	41	7	48
2018 Janeiro	52	11	63
2017 Dezembro	58	13	71
2017 Novembro	62	11	73
2017 Outubro	40	10	50
2017 Setembro	46	9	55
2017 Agosto	52	18	70
2017 Julho	33	10	43
2017 Junho	51	9	60
2017 Maio	64	14	78
2017 Abril	34	8	42
2017 Mar�o	45	2	47
2017 Fevereiro	36	10	46
2017 Janeiro	50	6	56
2016 Dezembro	29	7	36
2016 Novembro	23	7	30
2016 Outubro	54	3	57
2016 Setembro	83	9	92
2016 Agosto	30	3	33
2016 Julho	13	7	20
2016 Junho	2	8	10
2016 Maio	27	0	27
2016 Abril	45	1	46
2016 Mar�o	53	10	63
2016 Fevereiro	87	20	107
2016 Janeiro	67	10	77
2015 Dezembro	46	13	59
2015 Novembro	59	20	79
2015 Outubro	120	48	168
2015 Setembro	114	80	194

Mostrar tudo

Indexada em:

Siga-nos:

Estatísticas

Indexada em:

Siga-nos:

Estatísticas

Receba a nossa Newsletter