A population‐based evaluation of the thrombolysis in myocardial infarction risk score for unstable angina and non‐ST elevation myocardial infarction

Abstract

SummaryBackground: The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) for unstable angina/non-ST elevation myocardial infarction (MI) was developed in patients presenting with unstable angina accompanied by high-risk features or non-ST elevation MI to determine early risk stratification.Hypothesis: The validity in patients presenting for emergency care with symptoms suggestive of acute coronary syndrome (ACS) has not been well established, and the present study sought to do so by evaluating the TIMI-RS in a prospective fashion.Methods: A prospective TIMI-RS using seven variables was calculated in 245 patients admitted to the hospital with symptoms suggestive of ACS: (1) age > 65, (2) three or more cardiac risk factors, (3) ST deviation, (4) aspirin use within 7 days, (5) two or more anginal events over 24 h, (6) history of coronary stenosis, and (7) elevated troponin. Patients were contacted at 30 days and data were collected concerning major adverse cardiac events.Results: In patients presenting with chest pain, a higher TIMI-RS was associated with an increase in major adverse cardiac events within 30 days. We found that the 30-day event rate was 0% for a score of 1, 20% for a score of 2, 24% for a score of 3, 42% for a score of 4, 52% for a score of 5, and 70% for a score of 6 or 7 (p < 0.0001).

Prospective validation of Thrombolysis in Myocardial Infarction and front door Thrombolysis in Myocardial Infarction risk scores in Chinese patients presenting to the ED with chest pain

“…Our study included all ED patients with possible cardiac chest pain and was thus composed of more patients with low and intermediate risks of adverse cardiac outcomes than some of the previous studies [7,11]. Our results were similar to those of previous studies, showing a rise in 30 day MACE with increasing TIMI [8,10,11] and FDTIMI [10].…”

“…Other studies also suggest that TIMI correlates with adverse cardiac outcomes [11][12][13], although one suggested it was not valid [14]. Morris also studied FDTIMI, which is similar to TIMI, except it does not require cardiac markers for completion [10], yielding a range of 0 to 6.…”

Performance of a Population-based Cardiac Risk Stratification Tool in Asian Patients with Chest Pain

“…1,2 Most clinical prediction rules have been derived and validated in mixed-race groups of patients [3][4][5][6][7][8][9][10][11][12][13] and may not account for variances seen among racial or ethnic groups. Inaccuracy of risk stratification tools could lead to misdiagnosis, suboptimal treatment, increased morbidity or mortality of patients, and increased health care spending.…”

“…Multiple clinical prediction rules have been developed to evaluate patients with suspected acute coronary syndrome (ACS), including the well-known Goldman criteria, [4][5][6] TIMI risk score, [7][8][9] and the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI). [10][11][12][13] These risk stratification tools use elements of the patient's history, physical examina-tion, and diagnostic test results to provide diagnostic probabilities or prognostic information.…”

Aplicación de una puntuación de riesgo coronario (TIMI Risk Score) en una población no seleccionada de pacientes que consultan por dolor torácico en un servicio de urgencias

“…No obstante, hay poca información acerca de su aplicabilidad en la práctica clínica diaria más allá de los ensayos en los que se desarrolló y en poblaciones no seleccionadas, donde la presencia de cambios eléctricos o la elevación de enzimas cardíacas fueron criterios de inclusión en la mayoría de estos estudios 23,29,30 . Bartholomew et al 31 evaluaron a 245 pacientes consecutivos ingresados por dolor torácico y el TRS fue un potente predictor de eventos. La tasa tan elevada de estos eventos a los 30 días, del 20% para un TRS = 2 y > 50% para TRS ≥ 5, refleja a una población de riesgo alto, superior incluso a la del trabajo original del grupo TIMI (más del 70% de sujetos con cambios eléctricos y un 30% presentaba signos de insuficiencia cardíaca).…”