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.
OBJECTIVE
We evaluated the TIMI Risk Score for Unstable Angina and Non-ST Elevation Myocardial Infarction for predicting clinical outcomes and the efficacy of tirofiban in non-ST elevation acute coronary syndromes.


RESULTS
Developed in TIMI 11B, the risk score is calculated as the sum of seven presenting characteristics (age > or =65 years, > or =3 cardiac risk factors, documented coronary disease, recent severe angina, ST deviation > or =0.5 mm, elevated cardiac markers, prior aspirin use). The risk score was validated in the PRISM-PLUS database (n=1915) and tested for interaction with the efficacy of tirofiban+heparin vs heparin alone. The risk score revealed an increasing gradient of risk for death, myocardial infarction or recurrent ischaemia at 14 days ranging from 7.7-30.5% (P<0.001). Dichotomized at the median, patients with a score > or =4 derived a greater relative risk reduction with tirofiban (P((Interaction))=0.025). Among patients with normal creatine kinase myocardial bands, the risk score showed a 3.5-fold gradient of risk (P<0.001) and identified a population that derived significant benefit from tirofiban (RR 0.73, P=0.027).


CONCLUSIONS
The TIMI Risk Score is a simple clinical tool for risk assessment that may aid in the early identification of patients who should be considered for treatment with potent antiplatelet therapy.
Morrow
D A
DA
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Antman
E M
EM
Snapinn
S M
SM
McCabe
C H
CH
Theroux
P
P
Braunwald
E
E
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D003402:Creatine Kinase / Q000097:blood / Q000187:drug effects; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography; D023381:Endpoint Determination; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007527:Isoenzymes / Q000097:blood / Q000187:drug effects; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D016019:Survival Analysis; D013577:Syndrome; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000925:Anticoagulants; D015415:Biomarkers; D007527:Isoenzymes; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D006493:Heparin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D000077466:Tirofiban