The TIMI risk score for unstable angina/non–ST-elevation MI: a method for prognostication and therapeutic decision making

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).

Section: Timi-rs Patient Stratificationsupporting

confidence: 90%

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

Bartholomew

Sheps

Monroe

et al. 2004

“…[12][13][14][15][16][17][18][19][20][21][22][23] The majority of these included elevated cardiac markers and ECG changes as independent predictors of adverse outcomes. Unfortunately, there are limited data on risk assessment of "subacute" patients with ACS after initial presentation.…”

Section: Timing Of Heart Rate Assessmentmentioning

confidence: 99%

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Kovar

Cannon

Bentley

et al. 2004

Background: Lower admission heart rate (HR) is known to predict favorable outcome in ST‐elevation acute myocardial infarction. However, there are limited short‐term and no long‐term data available regarding the prediction value of the initial HR in patients with the full spectrum of acute coronary syndromes (ACS). In addition, it is unknown whether the HR obtained later during hospitalization for ACS (i.e., Day 2 or 3) remains prognostically valuable. Hypothesis: The aim of this study was to investigate the utility of the initial and delayed HR in predicting outcome in patients with ACS. Methods: We examined mortality at 30 days and 10 months in 10,267 patients with ACS enrolled in the oral glycoprotein IIb/IIIa inhibition with Orofiban in Patients with Unstable coronary Syndromes‐Thrombolysis In Myocardial Infarction (OPUS‐TIMI) 16 trial. Patients were stratified by HR and day from onset of ACS into the following groups: (1) HR < 60 beats/min, (2) HR 60‐80 beats/min, (3) HR 80‐100 beats/min, (4) HR > 100 beats/min; and HR obtained on (1) Day 1, (2) Day 2, and (3) Day 3. Results: By univariate analysis, mortality at 30 days and at 10 months increased progressively with higher HR strata (1.4 vs. 1.6 vs. 2.3 vs. 5.6%, p < 0.001, and 2.6 vs. 4.2 vs. 6.5 vs. 11.8%, p < 0.001, respectively). Elevated HR remained associated with mortality irrespective of time from onset of ACS. Conclusions: Higher initial and delayed HR is highly predictive of higher short‐ and long‐term mortality in patients with ACS. This is a simple marker that could be easily used in risk assessment.

“…Upon admission, all the patients were stratified with the use of the thrombolysis in myocardial infarction (TIMI) risk score, as previously described. 8 …”

Section: Treatment Strategymentioning

confidence: 99%

Neutrophil Count on Admission Predicts Major In‐hospital Events in Patients with a Non‐ST‐Segment Elevation Acute Coronary Syndrome

Karabinos

Koulouris

Kranidis

et al. 2009

Background: Inflammation plays a key role in the pathogenesis of acute coronary syndromes (ACS). In this context we assessed neutrophil count as a predictor of major in-hospital events in patients admitted for a non-ST-segment elevation (NSTE) ACS. Methods: We measured neutrophils on admission in 160 patients with a NSTE ACS and we correlated their count with the incidence of a combined in-hospital end point including: cardiac death, acute heart failure, ST-segment elevation myocardial infarction, and recurrent myocardial ischemia. Results: Patients who had a major in-hospital event also had a higher neutrophil count (P = 0.02) and higher serum levels of troponin I (P = 0.04). In the univariate logistic regression analysis, in-hospital major events could be predicted by troponin I >0.07 ng/mL (odds ratio [OR]: 5.65, 95% confidence interval [CI]: 1.26-25.32, P = 0.02), white blood cell count >8650 cells/µL (OR: 2.68, 95% CI: 1.03-6.95, P = 0.04), neutrophil count >6700 cells/µL (OR: 7.74, 95% CI: 2.79-21.47, P < 0.001), and C-reactive protein >0.97 mg/dL (OR: 3.56, 95% CI: 1.13-11.19, P = 0.02). However, in multivariate regression, neutrophil count >6700 cells/µL (OR: 6.52, 95% CI: 1.56-27.22, P = 0.01) was the only independent in-hospital prognostic factor. Conclusions: In patients with a NSTE ACS of moderate or high risk, neutrophil count on admission may identify those who are at risk of having an adverse in-hospital outcome.