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. 2006 Dec 5;27(2):74–78. doi: 10.1002/clc.4960270206

A population‐based evaluation of the thrombolysis in myocardial infarction risk score for unstable angina and non‐ST elevation myocardial infarction

Beth A Bartholomew 1,2,✉, David S Sheps 2, Stephen Monroe 2, Susan McGorray 2, Karen Smith 2, Carl J Pepine 2
PMCID: PMC6654083  PMID: 14979624

Abstract

Background: The Thrombolysis in Myocardial Infarction risk score (TIMI‐RS) for unstable angina/non‐ST elevation myocardial infarction (MI) was developed in patients presenting with unstable angina accompanied by high‐risk features or non‐ST elevation MI to determine early risk stratification.

Hypothesis: The validity in patients presenting for emergency care with symptoms suggestive of acute coronary syndrome (ACS) has not been well established, and the present study sought to do so by evaluating the TIMI‐RS in a prospective fashion.

Methods: A prospective TIMI‐RS using seven variables was calculated in 245 patients admitted to the hospital with symptoms suggestive of ACS: (1) age > 65, (2) three or more cardiac risk factors, (3) ST deviation, (4) aspirin use within 7 days, (5) two or more anginal events over 24 h, (6) history of coronary stenosis, and (7) elevated troponin. Patients were contacted at 30 days and data were collected concerning major adverse cardiac events.

Results: In patients presenting with chest pain, a higher TIMI‐RS was associated with an increase in major adverse cardiac events within 30 days. We found that the 30‐day event rate was 0% for a score of 1, 20% for a score of 2, 24% for a score of 3, 42% for a score of 4, 52% for a score of 5, and 70% for a score of 6 or 7 (p < 0.0001).

Conclusions: The TIMI‐RS successfully differentiates early risk for major adverse cardiac events in a general population presenting with symptoms suggestive of acute coronary syndrome. A simple bedside calculation of the TIMI‐RS provides rapid risk stratification, allowing facilitation of therapeutic decision making in patients with symptoms suggestive of ACS.

Keywords: acute coronary syndrome, unstable angina, myocardial infarction, ST‐segment deviation, troponin

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References

  • 1. Murphy SL: Deaths: Final data for 1998. Natl Vital Stat Rep 2000; 48: 1–105 [PubMed] [Google Scholar]
  • 2. Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP: Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med 1997; 29: 116–125 [DOI] [PubMed] [Google Scholar]
  • 3. Storrow AB, Gibler WB: Chest pain centers: Diagnosis of acute coronary syndromes. Ann Emerg Med 2000; 35: 449–461 [PubMed] [Google Scholar]
  • 4. McCarthy BD, Beshansky JR, D'Agostino RB, Selker HP: Missed diagnoses of acute myocardial infarction in the emergency department: Results from a multicenter study. Ann Emerg Med 1993; 22: 579–582 [DOI] [PubMed] [Google Scholar]
  • 5. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP: Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000; 342: 1163–1170 [DOI] [PubMed] [Google Scholar]
  • 6. Heeschen C, Hamm CW, Goldmann B, Deu A, Langenbrink L, White HD: Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. PRISM Study Investigators. Platelet Receptor Inhibition in Ischemic Syndrome Management. Lancet 1999; 354: 1757–1762 [DOI] [PubMed] [Google Scholar]
  • 7. Antman EM, Sacks DB, Rifai N, McCabe CH, Cannon CP, Braunwald E: Time to positivity of a rapid bedside assay for cardiac‐specific troponin T predicts prognosis in acute coronary syndromes: A Thrombolysis in Myocardial Infarction (TIMI) 11A substudy. J Am Coll Cardiol 1998; 31: 326–330 [DOI] [PubMed] [Google Scholar]
  • 8. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, Fischer GA, Fung AY, Thompson C, Wybenga D, Braunwald E: Cardiac‐specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335: 1342–1349 [DOI] [PubMed] [Google Scholar]
  • 9. Kontos MC, Anderson FP, Alimard R, Ornato JP, Tatum JL, Jesse RL: Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J Am Coll Cardiol 2000; 36: 1818–1823 [DOI] [PubMed] [Google Scholar]
  • 10. Lindahl B, Venge P, Wallentin L: The FRISC experience with troponin T. Use as decision tool and comparison with other prognostic markers. Eur Heart J 1998; 19 (suppl N): 51–58 [PubMed] [Google Scholar]
  • 11. Cohen M, Hawkins L, Greenberg S, Fuster V: Usefulness of ST‐segment changes in greater than or equal to 2 leads on the emergency room electrocardiogram in either unstable angina pectoris or non‐Q‐wave myocardial infarction in predicting outcome. Am J Cardiol 1991; 67: 1368–1373 [DOI] [PubMed] [Google Scholar]
  • 12. Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, O'Hanesian MA, Wagner GS, Kleiman NS, Harrell FE Jr, Califf RM, Topol EJ: Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med 1996; 335: 1333–1341 [DOI] [PubMed] [Google Scholar]
  • 13. Ohman EM, Armstrong PW, White HD, Granger CB, Wilcox RG, Weaver WD, Gibler WB, Stebbins AL, Cianciolo C, Califf RM, Topol EJ: Risk stratification with a point‐of‐care cardiac troponin T test in acute myocardial infarction. GUSTOIII Investigators. Global Use of Strategies To Open Occluded Coronary Arteries. Am J Cardiol 1999; 84: 1281–1286 [DOI] [PubMed] [Google Scholar]
  • 14. Jernberg T, Lindahl B, Wallentin L: ST‐segment monitoring with continuous 12‐lead ECG improves early risk stratification in patients with chest pain and ECG nondiagnostic of acute myocardial infarction. J Am Coll Cardiol 1999; 34: 1413–1419 [DOI] [PubMed] [Google Scholar]
  • 15. Cannon CP, McCabe CH, Stone PH, Rogers WJ, Schactman M, Thompson BW, Pearce DJ, Diver DJ, Kells C, Feldman T, Williams M, Gibson RS, Kronenberg MW, Ganz LI, Anderson HV, Braunwald E: The electrocardiogram predicts one‐year outcome of patients with unstable angina and non‐Q wave myocardial infarction: Results of the TIMI III Registry ECG Ancillary Study. Thrombolysis in Myocardial Ischemia. J Am Coll Cardiol 1997; 30: 133–140 [DOI] [PubMed] [Google Scholar]
  • 16. Boersma E, Pieper KS, Steyerberg EW, Wilcox RG, Chang WC, Lee KL, Akkerhuis KM, Harrington RA, Deckers JW, Armstrong PW, Lincoff AM, Califf RM, Topol EJ, Simoons ML: Predictors of outcome in patients with acute coronary syndromes without persistent ST‐segment elevation. Results from an international trial of 9,461 patients. The PURSUIT Investigators. Circulation 2000; 101: 2557–2567 [DOI] [PubMed] [Google Scholar]
  • 17. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, Simoons M, Aylward P, Van de Werf F, Califf RM: Predictors of 30‐day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO‐I Investigators. Circulation 1995; 91: 1659–1668 [DOI] [PubMed] [Google Scholar]
  • 18. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E: The TIMI risk score for unstable angina/non‐ST elevation MI: A method for prognostication and therapeutic decision making. J Am Med Assoc 2000; 284: 835–842 [DOI] [PubMed] [Google Scholar]
  • 19. Antman EM, Cohen M, Radley D, McCabe C, Rush J, Premmereur J, Braunwald E: Assessment of the treatment effect of enoxaparin for unstable angina/non‐Q‐wave myocardial infarction. TIMI 11B‐ESSENCE meta‐analysis. Circulation 1999; 100: 1602–1608 [DOI] [PubMed] [Google Scholar]
  • 20. Antman EM, McCabe CH, Gurfinkel EP, Turpie AG, Bernink PJ, Salein D, Bayes de Luna A, Fox K, Lablanche JM, Radley D, Premmereur J, Braunwald E: Enoxaparin prevents death and cardiac ischemic events in unstable angina/non‐Q‐wave myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) 11B trial. Circulation 1999; 100: 1593–1601 [DOI] [PubMed] [Google Scholar]
  • 21. Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, Neumann FJ, Robertson DH, DeLucca PT, DiBattiste PM, Gibson CM, Braunwald E: Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001; 344: 1879–1887 [DOI] [PubMed] [Google Scholar]
  • 22. Morrow DA, Antman EM, Snapinn SM, McCabe CH, Théroux P, Braunwald E: An integrated clinical approach to predicting the benefit of tirofiban in non‐ST elevation acute coronary syndromes. Application of the TIMI Risk Score for UA/NSTEMI in PRISM‐PLUS. Eur Heart J 2002; 23: 223–229 [DOI] [PubMed] [Google Scholar]
  • 23. Stone PH, Thompson B, Anderson HV, Kronenberg MW, Gibson RS, Rogers WJ, Diver DJ, Théroux P, Warnica JW, Nasmith JB, Kells C, Kleiman N, McCabe CH, Schactman M, Knatterud GL, Braunwald E: Influence of race, sex, and age on management of unstable angina and non‐Q‐wave myocardial infarction: The TIMI III registry. J Am Med Assoc 1996; 275: 1104–1112 [PubMed] [Google Scholar]
  • 24. Scirica BM, Cannon CP, Antman EM, Murphy SA, Morrow DA, Sabatine MS, McCabe CH, Gibson CM, Braunwald E: Validation of the Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina pectoris and non‐ST‐elevation myocardial infarction in the TIMI III registry. Am J Cardiol 2000; 90: 303–305 [DOI] [PubMed] [Google Scholar]
  • 25. Investigators PT: Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med 1998; 339: 436–443 9705684 [Google Scholar]
  • 26. Armstrong PW, Fu Y, Chang WC, Topol EJ, Granger CB, Betriu A, Van de Werf F, Lee KL, Califf RM: Acute coronary syndromes in the GUSTO‐IIb trial: Prognostic insights and impact of recurrent ischemia. The GUSTO‐IIb Investigators. Circulation 1998; 98: 1860–1868 [DOI] [PubMed] [Google Scholar]
  • 27. Zaacks SM, Liebson PR, Calvin JE, Parrillo JE, Klein LW: Unstable angina and non‐Q wave myocardial infarction: Does the clinical diagnosis have therapeutic implications? J Am Coll Cardiol 1999; 33: 107–118 [DOI] [PubMed] [Google Scholar]
  • 28. Maseri A, Rebuzzi AG, Cianflone D: Need for a composite risk stratification of patients with unstable coronary syndromes tailored to clinical practice. Circulation 1997; 96: 4141–4142 [PubMed] [Google Scholar]

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