Key result
The TIMI risk score was not an independent predictor of death and new MI, with similar event rates in low and high-risk groups with positive cardiac markers (15.1% vs 17.8%, P=0.7).
Why the study?
Does the TIMI risk score accurately predict 30-day death and new MI in individual patients with UA/NSTEMI?
Cohort (n=500)
Yes
Does the TIMI risk score accurately predict 30-day death and new MI in individual patients with UA/NSTEMI?
The TIMI risk score has limited value for individual risk stratification in UA/NSTEMI, whereas positive cardiac markers (troponin) are more powerful prognostic indicators.
May limit TIMI score for individual risk stratification in troponin-positive UA/NSTEMI; leaves open validation in prospective cohorts.
OBJECTIVES: To determine the value of the TIMI risk score in the individual risk stratification of patients with unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). BACKGROUND: TIMI risk score is a validated tool to identify groups of patients at high risk for major cardiac events. Its prognostic value in individual patients with current diagnostic tools and therapy is unknown. METHODS: TIMI risk score was assessed in patients with UA/NSTEMI admitted to six Belgian hospitals and related to clinical outcome at 30 days. RESULTS: Of the 500 patients enrolled, 49.4% were placed in the low TIMI risk group (score = 0-3) and 50.6% in the high-risk group (score = 4-7). Multivariate analysis identified raised cardiac markers and invasive strategy, but not high TIMI risk score as independent predictors of death and new myocardial infarction (MI). Moreover, the incidence of death and MI in the low TIMI risk group with positive cardiac markers was not lower than in the high TIMI risk group with positive markers: 15.1% versus 17.8% (P = 0.7). CONCLUSIONS: TIMI risk score is of limited value for individual risk stratification. The presence of positive cardiac markers (troponin) appears to be a more powerful prognostic marker.
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Vorlat et al. (2008) conducted a cohort in unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI) (n=500). Low TIMI risk score (0-3) with positive cardiac markers vs. High TIMI risk score (4-7) with positive cardiac markers was evaluated on death and new myocardial infarction (MI) (p=0.7). The TIMI risk score was not an independent predictor of death and new MI, with similar event rates in low and high-risk groups with positive cardiac markers (15.1% vs 17.8%, P=0.7).
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