Validity of TIMI Score for Predicting 14-Day Mortality of Non-ST Elevation Myocardial Infarction Patients

Abstract

Background Accurate management of non-ST elevation myocardial infarction (NSTEMI) patients can be achieved by stratifying risks as early as possible on hospital admission. Previously, the Thrombolysis in Myocardial Infarction (TIMI) risk score has been validated and used on patients presenting with NSTEMI or unstable angina (UA) in developed countries. The aim of this study was to assess the validity of the TIMI risk score in patients presenting with NSTEMI in Pakistan. Methods This cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. The receiver operating characteristic (ROC) curve analysis was performed, and area under the curve (AUC) along with 95% confidence interval (CI) was reported. Univariate and multivariate logistic regression analysis was performed and odds ratio (OR) along with 95% CI was reported. Results This cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. Validity of TIMI score in predicting hospital mortality 14 days after the diagnosis of NSTEMI in a population in Pakistan was assessed by ROC curve and logistic regression analysis. The AUC of the TIMI score for predicting 14-day outcome was 0.788 [95% CI: 0.689-0.887], with optimal cutoff of ≥4 with sensitivity of 77.78%. On multivariate analysis, cardiac arrest at presentation and the TIMI risk score were found to be independent predictors of 14-day mortality with adjusted ORs of 136.49 [10.23-1821.27] and 2.67 [1.09-6.57], respectively. Conclusions The TIMI risk score is a useful and simple score for the stratification of patients with high risk of 14-day mortality with reasonably acceptable discriminating ability in patients with NSTEMI acute coronary syndrome.

Correlation between scores and outcome in Acute Coronary Syndrome patients

“…In our study, the results approved that higher TIMI score was associated with higher incidence of in hospital complications and this is matched with the result obtained by [12] that revealed the TIMI risk score is a useful and simple score for the stratification of patients with high risk of 14-day mortality with reasonably acceptable discriminating ability in patients with NSTEMI-ACS. Therefore, its use among clinicians is suggested to apply strategic and precise interventions in monitoring these patients.…”

Data analytics approach for short- and long-term mortality prediction following acute non-ST-elevation myocardial infarction (NSTEMI) and Unstable Angina (UA) in Asians

“…Although it demonstrated an AUC of 0.80 for 30-day mortality prediction in Western populations [ 70 ], its applicability in Asian cohorts has been less convincing. Kumar et al (2021) found a TIMI score AUC of 0.78 in Pakistan [ 71 ], while a study in China found AUCs of 0.52, 0.50, and 0.52 for 6-month, 1-year, and 2-year mortality risks [ 72 ]. According to Indonesian research, the 14-day mortality prediction AUC for NSTEMI was 0.61 and 0.63 for UA [ 73 ], while Malaysian data revealed an in-hospital mortality prediction AUC of only 0.55 [ 51 ].…”

“…The TIMI risk score for NSTEMI/UA was developed to estimate the 14-day mortality risk and has remained unchanged for over two decades [5,24,62]. Although it demonstrated an AUC of 0.80 for 30-day mortality prediction in Western populations [70], its applicability in [71], while a study in China found AUCs of 0.52, 0.50, and 0.52 for 6-month, 1-year, and 2-year mortality risks [72]. According to Indonesian research, the 14-day mortality prediction AUC for NSTEMI was 0.61 and 0.63 for UA [73], while Malaysian data revealed an in-hospital mortality prediction AUC of only 0.55 [51].…”

Factors Associated With Mortality During the First Year Post Infarction: Survival Analysis of Patients With Acute Myocardial Infarction in Colombia

“…Risk scores on the TIMI scale and Killip classification may serve as useful predictors of mortality after an AMI, with higher mortality risk associated with greater severity of congestive heart failure at presentation [ 18 , 19 ]. It is noteworthy that the type of intervention, specifically CABG, was identified as a significant predictor of lower mortality risk [ 20 ].…”