Frequency and Clinical Correlates of Changes in Thrombolysis In Myocardial Infarction Risk Score During Observation Period at Emergency Department in “Low-Risk” Patients With Acute Chest Pain

Pelliccia, Francesco; Salvini, P; Cartoni, Domenico; Polletta, B.; Pasceri, Vincenzo; Pristipino, Christian; Richichi, Giuseppe; Mercuro, Giuseppe; Tanzi, Pietro

doi:10.1016/j.amjcard.2005.09.126

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…The goal of the evaluation of a patient who presents to the ED with chest pain has changed from diagnosis to risk stratification. The use of the History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) or Thrombolysis in Myocardial Infarction (TIMI) risk scores, provide diagnostic information, among others, unfortunately in our study, the history, electrocardiogram, and troponin are not elements available for matching.…”

Section: Discussionmentioning

confidence: 99%

Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain

Bellolio

Sangaralingham

Schilz

et al. 2017

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain

Bellolio

Sangaralingham

Schilz

et al. 2017

Academic Emergency Medicine

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“…14,15 Physicians explicitly interpreted the TIMI risk score in practice without knowledge of the outcome in three studies. [17][18][19] All studies that reported the fidelity of patient follow-up had lost-to-follow-up rates of less than 10%.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…However, all studies validated the TIMI risk score in emergency department patients and assessed the same predictor variables and the same composite outcome. Thirty-day outcome data were available for all studies included in the quantitative synthesis except one 17 in which outcomes were assessed at the time of discharge from hospital or emergency department. The prevalence of cardiac events varied from 3.7% to 25.5% between studies.…”

Section: Heterogeneitymentioning

confidence: 99%

“…At a cut-off of > 1, the sensitivity decreased to 90.6% (95% CI 89.3-91.8; I 2 = 97.9%) and the specificity increased to 50.9% (95% CI 50.0-51.7; I 2 = 99.5%). We also conducted a sensitivity analysis excluding the study by Pellicia and colleagues, 17 because this study reported in-hospital rather than 30-day outcomes. There were no substantial differences in the classification performance of the TIMI risk score when this study was excluded (data not shown).…”

Section: Classification Characteristics and Diagnostic Performancementioning

confidence: 99%

“…[16][17][18][19][20][21][22][23] Three studies were conducted in the United States, two in the United Kingdom, two in Spain, two in Italy and one in Canada. The mean age ranged from 53.6 to 71.3 years.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis

Hess

Agarwal

Chandra

et al. 2010

Canadian Medical Association Journal

113

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C hest pain is a common presenting complaint in the emergency department that requires efficient risk stratification, timely initiation of treatment in highrisk patients and safe determination of patient disposition. Several studies have been published that stratify the risk of patients in the emergency department with chest pain. [1][2][3][4][5] However, only the Thrombolysis in Myocardial Infarction (TIMI) risk score, which was initially developed for use in patients with unstable angina or non-ST-segment elevation myocardial infarction or both, 6 has been broadly validated in several independent emergency department populations with chest pain and thus constitutes the highest level of evidence available. The TIMI risk score assigns each of seven predictors a value of one point, allowing stratification of patients into one of eight prognostic categories (Box 1). 6 The clinical end points are acute myocardial infarction, coronary revascularization and death from any cause.A robust estimate of the performance of the TIMI risk score obtained from a systematic review may prove useful to both clinicians and researchers. Clinicians would have a reliable quantitative estimate of a patient's short-term risk of a cardiac event. This could be used as an adjunct to clinical acumen and as a tool to communicate risk to patients in a shared decision-making model of care.7 Researchers would also have an estimate of the prognostic accuracy of the TIMI risk score derived from different practice settings and patient populations that represent a wide variety of ethnic backgrounds. This estimate may serve as a useful baseline for comparison as emerging clinical prediction rules and imaging modalities continue to refine our approach to diagnosis and risk stratification in patients in the emergency department with potential acute coronary syndromes.We conducted a comprehensive systematic review and meta-analysis to assess the methodological quality and prognostic performance of studies that had prospectively validated the TIMI risk score in patients in the emergency department. MethodsThis systematic review and meta-analysis adheres to the reporting guidelines of Meta-analysis of Observational Studies in Epidemiology (MOOSE) 8 and the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement as applicable to meta-analyses of observational studies. Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score uses clinical data to predict the short-term risk of acute myocardial infarction, coronary revascularization or death from any cause. It was originally developed for use in patients with unstable angina or non-STelevation myocardial infarction. We sought to expand the clinical application of the TIMI risk score by assessing its prognostic accuracy in patients in the emergency department with potential acute coronary syndromes.

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Does This Patient With Chest Pain Have Acute Coronary Syndrome?

Wang

Rymer

Goldstein

et al. 2015

JAMA

183

135

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Frequency and Clinical Correlates of Changes in Thrombolysis In Myocardial Infarction Risk Score During Observation Period at Emergency Department in “Low-Risk” Patients With Acute Chest Pain

Cited by 7 publications

References 16 publications

Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain

Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain

Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis

Does This Patient With Chest Pain Have Acute Coronary Syndrome?

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