TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation

Morrow, David A.; Antman, Elliott M.; Charlesworth, Andrew; Cairns, Richard; Murphy, Sabina A.; Lemos, James A. de; Giugliano, Robert P.; McCabe, Carolyn H.; Braunwald, Eugene

doi:10.1161/01.cir.102.17.2031

Cited by 1,351 publications

(1,022 citation statements)

References 24 publications

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“…This score was validated in patients with prior myocardial infarction and in patients stabilized after an ACS 16. When applying this score in the IMPROVE‐IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) study, high‐risk patients derived the greatest benefit from the addition of ezetimibe to statin therapy 21. This finding is consistent with our findings and emphasize that high‐risk patients may derive the most benefit from guideline‐recommended treatment.…”

Section: Discussionsupporting

confidence: 85%

Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

Hammer

Iakobishvili

Hasdai

et al. 2018

JAHA

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BackgroundPatients who have had an acute coronary syndrome (ACS) are at increased risk of recurrent cardiovascular events; however, paradoxically, high‐risk patients who may derive the greatest benefit from guideline‐recommended therapies are often undertreated. The aim of our study was to examine the management, clinical outcomes, and temporal trends of patients after ACS stratified by the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention, a recently validated clinical tool that incorporates 9 clinical risk factors.Methods and ResultsIncluded were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2008 and 2016. Patients were stratified by the TIMI risk score for secondary prevention to low (score 0–1), intermediate (2), or high (≥3) risk. Clinical outcomes included 30‐day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1‐year mortality. Of 6827 ACS patients enrolled, 35% were low risk, 27% were intermediate risk, and 38% were high risk. Compared with the other risk groups, high‐risk patients were older, were more commonly female, and had more renal dysfunction and heart failure (P<0.001 for each). High‐risk patients were treated less commonly with guideline‐recommended therapies during hospitalization (percutaneous coronary intervention) and at discharge (statins, dual‐antiplatelet therapy, cardiac rehabilitation). Overall, high‐risk patients had higher rates of 30‐day major adverse cardiac events (7.2% low, 8.2% intermediate, and 15.1% high risk; P<0.001) and 1‐year mortality (1.9%, 4.6%, and 15.8%, respectively; P<0.001). Over the past decade, utilization of guideline‐recommended therapies has increased among all risk groups; however, the rate of 30‐day major adverse cardiac events has significantly decreased among patients at high risk but not among patients at low and intermediate risk. Similarly, the 1‐year mortality rate has decreased numerically only among high‐risk patients.ConclusionsDespite an improvement in the management of high‐risk ACS patients, they are still undertreated with guideline‐recommended therapies. Nevertheless, the outcome of high‐risk patients after ACS has significantly improved in the past decade, thus they should not be denied these therapies.

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Section: Discussionsupporting

confidence: 85%

Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

Hammer

Iakobishvili

Hasdai

et al. 2018

JAHA

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“…In the past years, several multivariate algorithms have been developed in patients with CP for estimating the need of intensive care [3,[5][6][7]31,32]. However, those studies were performed before troponin testing was routinely available, thus including patients considered at high risk, per se, to date.…”

Section: Discussionmentioning

confidence: 99%

“…In low-risk patients, a stress test aids the evaluation of suspected coronary disease and it is usually performed in the Emergency Department (ED), in the CP unit, or on an outpatient basis shortly after discharge; however, submitting patients to this diagnostic strategy is usually based on unstandardized clinical judgment [2][3][4]. In patients with defined acute coronary syndrome, several prediction rules are available for risk stratification [5][6][7]; conversely, no study has validated the usefulness of a prediction rule including coronary risk factors [8][9][10][11] in a large cohort of patients with low-risk CP. Moreover, some of the major risk factors for atherosclerosis (eg, hypertension, hypercholesterolemia, obesity, cigarette smoking, family history) have been found to be weakly predictive of the likelihood of coronary events in this population [12,13].…”

Section: Introductionmentioning

confidence: 99%

A new simple risk score in patients with acute chest pain without existing known coronary disease

Conti

Vanni

Taglia

et al. 2010

The American Journal of Emergency Medicine

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Objective: To derive and validate a prediction rule in patients with acute chest pain (CP) without existing known coronary disease. Methods: Cohort study including 2233 patients with CP. Based on clinical judgment, 1435 were discharged as very low risk and the remaining 798 underwent exercise tolerance test (ETT). End point: 6-month composite of cardiovascular death, nonfatal myocardial infarction, and revascularization. The prediction rule was derived from a randomly selected test cohort (n = 1106) summing factors of variables selected by multivariate regression analysis: CP score higher than 6 (factor of 3), male gender, age older than 50 years, metabolic syndrome, and diabetes mellitus (factor of 1, for each). The prediction rule was validated in the remaining cohort (n = 1127). All patients with CP were categorized into 3 groups: group A (prediction rule 0-1), B (2-4), or C (5-6). Outcomes and prognostic yield of ETT were compared among each group. Results: In the test cohort, 55 patients (5%) reached the composite end point. Event rate increased as the prediction rule increased: 1% for group A, 6% for B, and 25% for C (P b .001). This pattern was confirmed in the validation cohort (P b .001). A normal ETT did not significantly improve the high (99%) negative predictive value in group A and did not succeed in excluding the composite end point (17%) in group C. Conclusions: In patients with acute CP without existing coronary disease, a prediction rule based on clinical characteristics provided a useful method for prognostication with possible implication in decision making.

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“…Numerous bedside tools have been developed to stratify patients with STEMI to identify a low-risk group of patients who are unlikely to experience complications above the background rate and who can be discharged from the hospital after a brief period of observation. The Zwolle primary PCI index (4) [7] and TIMI-STEMI [8]) and clearly identifies a majority of patients who can be discharged early. Although a more comprehensive score in the setting of primary PCI has since been reported (ie, the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications [CADILLAC] [9] score), we found that the Zwolle score was practical as a clinical bedside tool, with the ability to discriminate between high-and low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention?

Kotowycz

Syal

Afzal

et al. 2009

Canadian Journal of Cardiology

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TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation

Cited by 1,351 publications

References 24 publications

Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

A new simple risk score in patients with acute chest pain without existing known coronary disease

Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention?

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