Key result
Higher TIMI scores linked to increased 30-day MACE in ACS, reaching ~39% for highest-risk STEMI.
Why the study?
Patients with acute coronary syndrome have considerable variability in outcome and mortality risk, and the prognostic value of the TIMI risk score for predicting major adverse cardiac events needed validation.
Does the TIMI risk score predict 30-day major adverse cardiac events in patients with acute coronary syndrome?
Cohort (n=279)
No
Does the TIMI risk score predict 30-day major adverse cardiac events in patients with acute coronary syndrome?
The TIMI risk score is a valid bedside tool for predicting 30-day major adverse cardiac events in patients presenting with acute coronary syndrome.
Background: Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. Aim & objectives: This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TIMI risk score. Methods: This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & complete physical examinations were done. ST changes in electrocardiogram & CKMB/Troponin value were noted in data sheet. TIMI risk score was calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Results: In patient with UA/NSTEMI major adverse cardiac events were 0%, 4.2%, 6.9%, 12.5%, 13.6% and 33.3% with TIMI score 0/ 1, 2, 3, 4, 5 and 6/7 respectively. . In patients with STEMI group major adverse cardiac events were 0%, 0%, 0%, 0%, 7.1%, 9.5%, 10%, 17.6%, 19% and 38.5% with TIMI score 0, 1, 2, 3, 4, 5, 6, 7, 8 and more than 8 respectively. Conclusions: Increasing TIMI risk score was associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16063 University Heart Journal Vol. 8, No. 2, July 2012
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Ehsan et al. (2013) conducted a cohort in Acute Coronary Syndrome (ACS) (n=279). TIMI risk score vs. Lower TIMI risk score categories was evaluated on Major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) at 30 days (p=<0.01). Increasing TIMI risk scores were significantly associated with an increased risk of 30-day major adverse cardiac events in patients with acute coronary syndrome, reaching 33.3% in UA/NSTEMI and 38.5% in STEMI for the highest risk categories.
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