Usefulness of the TIMI risk score in predicting both short- and long-term outcomes in the Veterans Affairs Non-Q-Wave Myocardial Infarction Strategies In-Hospital (VANQWISH) Trial.
We sought to test the validity and clinical utility of the Thrombolysis In Myocardial Infarction (TIMI) risk score for patients who have non-Q-wave myocardial infarction. A post hoc analysis of the Veterans Affairs Non-Q-Wave Infarction Strategies In-Hospital (VANQWISH) Trial was performed, wherein patients were assigned a TIMI risk score from which both 30-day and 12-month outcomes (death, nonfatal myocardial infarction, or urgent revascularization) were assessed. At 30 days, the TIMI risk score showed a close match between observed and predicted probabilities of events after adjustment for overall event rates. The event rate at 30 days was 6% for a score of 0 to 2, 10% for a score of 3, 13% for a score of 4, and 14% for a score of 5 to 7 (p = 0.003 and c statistic 0.59). Discriminative ability of the score was greater in the conservative group at 30 days (p = 0.0004, c statistic 0.67). The score remained modestly predictive of events at 1 year (c statistic 0.60). Conservative strategy patients had better 30-day outcomes than the invasive strategy patients if their score was 0 to 2 (odds ratio 0.24, 95% confidence interval 0.08 to 0.76). No significant difference in outcomes between strategies was detected for a score > or =3. The TIMI risk score provides moderate incremental prognostic information in high-risk patients, during both short- and long-term follow-up.
Samaha
Frederick F
FF
Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. rick.samaha@med.va.gov
Kimmel
Stephen E
SE
Kizer
Jorge R
JR
Goyal
Abhinav
A
Wade
Michael
M
Boden
William E
WE
D000368:Aged; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D018450:Disease Progression; D023381:Endpoint Determination; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome
D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form