Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome

Zehra Jaffery, Michael P. Hudson, Gordon Jacobsen, Richard Nowak, James McCord

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS). Background: The ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain. Methods: We investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization). Results: There were 151 (16%) patients diagnosed with ACS. At 30 days there were 48 (5%) deaths, 84 (9%) myocardial infarctions, and 49 (5%) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 ± 1.3 vs. 1.7 ± 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age ≥65 years, ST segment deviation ≥0.5 mm elevated troponin I, and coronary stenosis ≥50%) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score. Conclusion: A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalJournal of Thrombosis and Thrombolysis
Volume24
Issue number2
DOIs
StatePublished - Oct 2007
Externally publishedYes

Fingerprint

Acute Coronary Syndrome
Hospital Emergency Service
Myocardial Infarction
Chest Pain
Troponin I
Coronary Stenosis
Cause of Death
Multivariate Analysis

Keywords

  • Acute coronary syndromes
  • Emergency department
  • Risk stratification

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome. / Jaffery, Zehra; Hudson, Michael P.; Jacobsen, Gordon; Nowak, Richard; McCord, James.

In: Journal of Thrombosis and Thrombolysis, Vol. 24, No. 2, 10.2007, p. 137-144.

Research output: Contribution to journalArticle

Jaffery, Zehra ; Hudson, Michael P. ; Jacobsen, Gordon ; Nowak, Richard ; McCord, James. / Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome. In: Journal of Thrombosis and Thrombolysis. 2007 ; Vol. 24, No. 2. pp. 137-144.
@article{5fe7c464750a473abc6daf5662ff638d,
title = "Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome",
abstract = "Objective: To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS). Background: The ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain. Methods: We investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization). Results: There were 151 (16{\%}) patients diagnosed with ACS. At 30 days there were 48 (5{\%}) deaths, 84 (9{\%}) myocardial infarctions, and 49 (5{\%}) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 ± 1.3 vs. 1.7 ± 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age ≥65 years, ST segment deviation ≥0.5 mm elevated troponin I, and coronary stenosis ≥50{\%}) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score. Conclusion: A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.",
keywords = "Acute coronary syndromes, Emergency department, Risk stratification",
author = "Zehra Jaffery and Hudson, {Michael P.} and Gordon Jacobsen and Richard Nowak and James McCord",
year = "2007",
month = "10",
doi = "10.1007/s11239-007-0013-0",
language = "English (US)",
volume = "24",
pages = "137--144",
journal = "Journal of Thrombosis and Thrombolysis",
issn = "0929-5305",
publisher = "Springer Netherlands",
number = "2",

}

TY - JOUR

T1 - Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome

AU - Jaffery, Zehra

AU - Hudson, Michael P.

AU - Jacobsen, Gordon

AU - Nowak, Richard

AU - McCord, James

PY - 2007/10

Y1 - 2007/10

N2 - Objective: To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS). Background: The ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain. Methods: We investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization). Results: There were 151 (16%) patients diagnosed with ACS. At 30 days there were 48 (5%) deaths, 84 (9%) myocardial infarctions, and 49 (5%) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 ± 1.3 vs. 1.7 ± 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age ≥65 years, ST segment deviation ≥0.5 mm elevated troponin I, and coronary stenosis ≥50%) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score. Conclusion: A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.

AB - Objective: To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS). Background: The ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain. Methods: We investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization). Results: There were 151 (16%) patients diagnosed with ACS. At 30 days there were 48 (5%) deaths, 84 (9%) myocardial infarctions, and 49 (5%) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 ± 1.3 vs. 1.7 ± 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age ≥65 years, ST segment deviation ≥0.5 mm elevated troponin I, and coronary stenosis ≥50%) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score. Conclusion: A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.

KW - Acute coronary syndromes

KW - Emergency department

KW - Risk stratification

UR - http://www.scopus.com/inward/record.url?scp=38449113017&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38449113017&partnerID=8YFLogxK

U2 - 10.1007/s11239-007-0013-0

DO - 10.1007/s11239-007-0013-0

M3 - Article

VL - 24

SP - 137

EP - 144

JO - Journal of Thrombosis and Thrombolysis

JF - Journal of Thrombosis and Thrombolysis

SN - 0929-5305

IS - 2

ER -