TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy - TIMI Risk Score for ST-Elevation Myocardial Infarction

Description:

TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy.

Hypothesis:

To develop and evaluate a convenient bed-side clinical risk score for predicting 30-day mortality at presentation of fibrinolytic-eligible patients with ST-elevation myocardial infarction (STEMI).

Study Design

Study Design:

Patients Enrolled: 14114

Drug/Procedures Used:

Data on patients with STEMI enrolled in Intravenous nPA for Treatment of Infarcting Myocardium Early II trial (n=14,114) were utilized to develop a TIMI risk score for STEMI. This risk score was created as the simple arithmetic sum of independent predictors of mortality weighted according to the adjusted odds ratios from logistic regression analysis.

Principal Findings:

Mean 30-day mortality was 6.7%. The TIMI risk score was constituted by 10 baseline variables, accounting for 97% of the predictive capacity of the multivariate model. These included age 65-74 years (2 points); age >75 years (3 points); diabetes, hypertension or angina (1 point); systolic blood pressure < 100 mmHg (3 points); heart rate >100 (2 points); Killip class II-IV (2 points); weight <67 Kg (1 point); anterior STEMI or LBBB (1 point) and time to treatment >4 hours (1 point). A graded increase in mortality was associated with increasing risk score with scores ranging from 0 (<1%) to >8 (35.9%, 40 fold increase; p<0.0001).

The simple TIMI risk score for STEMI captures the majority of prognostic information offered by a full logistic regression model and can be used to predict risk at the bedside.

Interpretation:

The TIMI risk score, unlike prior complex models, may assist physicians in risk stratifying patients with STEMI at presentation. Such risk stratification could help identify and facilitate early discharge of patients with STEMI at low-risk for cardiac events. Contrariwise, it may also help early identification of high-risk cohort that can then be targeted for aggressive strategies to help improve their outcomes.

References:

1. Morrow DA, Antman EM, Charlesworth A, et al. Circulation 2000;102:2031-7.

Clinical Topics: Prevention, Hypertension

Keywords: Odds Ratio, Thrombolytic Therapy, Myocardial Infarction, Coronary Disease, Blood Pressure, Risk Assessment, Heart Rate, Hypertension, Diabetes Mellitus, Logistic Models


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