Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome

Jaffery, Zehra; Hudson, Michael; Jacobsen, Gordon; Nowak, Richard M.; McCord, James

doi:10.1007/s11239-007-0013-0

Cited by 43 publications

(30 citation statements)

References 35 publications

(33 reference statements)

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“…39 When applied to patients in the ED with chest pain of unclear etiology, the TIMI score alone has not performed as well. 40 In a study of 3125 patients with chest pain of unclear etiology, the prognostic ability of the TIMI score to predict adverse events at 30 days was poor, 41 with an AUC of only 0.66. In a prospective multicenter study of 2440 patients, the HS outperformed the TIMI score.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

McCord

Cabrera

Lindahl

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background— The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. Methods and Results— Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs ( P =0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs ( P =0.03). Conclusions— Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.

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Section: Discussionmentioning

confidence: 99%

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

McCord

Cabrera

Lindahl

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…However, these studies included heterogeneous groups of populations with STEMI and non-STEMI patients, but the present study included 120 STEMI patients. There is a previous study done on closely similar number of study subjects (18).…”

Section: Discussionmentioning

confidence: 97%

Predictability of adverse clinical events following ST-elevation myocardial infarction by risk assessment tools

2016

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“…76 77 This simple instrument stratifies patients presenting chest pain according to the probability of mortality or myocardial infarction in the 30 days following the ED visit. [76][77][78] A result ≤2 is associated with low incidence (3%) of mortality or cardiac events; scores >2 are associated with a higher incidence (28%). Scores are obtained by summing values that correspond to the following characteristics: (1) age ≥65 years (1 point); (2) known coronary stenosis ≥50% or history of revascularisation (1 point); (3) deviation of the ST segment ≥0.5 mm (5 points) and (4) elevated rate of cardiac enzymes defined as troponins I ≥99th centile.…”

Section: Participantsmentioning

confidence: 99%

A prospective cohort study to refine and validate thePanic Screening Scorefor identifying panic attacks associated with unexplained chest pain in the emergency department

et al. 2013

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IntroductionPanic-like anxiety (panic attacks with or without panic disorder), a highly treatable condition, is the most prevalent condition associated with unexplained chest pain in the emergency department. Panic-like anxiety may be responsible for a significant portion of the negative consequences of unexplained chest pain, such as functional limitations and chronicity. However, more than 92% of panic-like anxiety cases remain undiagnosed at the time of discharge from the emergency department. The 4-item Panic Screening Score (PSS) questionnaire was derived in order to increase the identification of panic-like anxiety in emergency department patients with unexplained chest pain.Methods and analysisThe goals of this prospective cohort study were to (1) refine the PSS; (2) validate the revised version of the PSS; (3) measure the reliability of the revised version of the PSS and (4) assess the acceptability of the instrument among emergency physicians. Eligible and consenting patients will be administered the PSS in a large emergency department. Patients will be contacted by phone for administration of the criterion standard for panic attacks as well as by a standardised interview to collect information for other predictors of panic attacks. Multivariate analysis will be used to refine the PSS. The new version will be prospectively validated in an independent sample and inter-rater agreement will be assessed in 10% of cases. The screening instrument acceptability will be assessed with the Ottawa Acceptability of Decision Rules Instrument.Ethics and disseminationThis study protocol has been reviewed and approved by the Alphonse-Desjardins research ethics committee. The results of the study will be presented in scientific conferences and published in peer-reviewed scientific journals. Further dissemination via workshops and a dedicated website is planned.

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Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome

Abstract: A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.

Cited by 43 publications

References 35 publications

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Predictability of adverse clinical events following ST-elevation myocardial infarction by risk assessment tools

A prospective cohort study to refine and validate thePanic Screening Scorefor identifying panic attacks associated with unexplained chest pain in the emergency department

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