Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome.
BACKGROUND
The seven-component Thrombolysis In Myocardial Infarction (TIMI) score has been used to risk stratify, and to guide the medical management of, patients with unstable angina or non-ST-elevation myocardial infarction. We assessed the usefulness of the risk score in predicting in-hospital and 30-day outcomes in such patients who were undergoing percutaneous coronary intervention.


METHODS
Using the TIMI score, 2501 patients with unstable angina or non-ST-elevation myocardial infarction were divided into low-risk (zero to two risk factors; n = 974), intermediate-risk (three to four risk factors; n = 1339), and high-risk (five to seven risk factors; n = 188) groups, and outcomes were compared.


RESULTS
Angiographic/clinical success and the rate of minor procedural events were similar among the three groups. A higher TIMI risk score was associated with more cardiac comorbid conditions and more complicated angiographic lesions: longer lesions (P = 0.0009), more thrombotic lesions (P = 0.03), more multivessel disease (P <0.0001), and more American College of Cardiology/American Heart Association type B2/C lesions (P = 0.05). Although the risk score did not predict interventional technical success or intraprocedural complications, a high score was associated with prolonged hospital stay, higher postprocedural peak troponin levels, and 30-day major adverse cardiac events. Stepwise logistic regression showed that in conjunction with lesion length and patient sex, a high score was an independent predictor of 30-day major adverse cardiac events (odds ratio = 2.3; 95% confidence interval: 1.1 to 4.1; C statistic = 0.62).


CONCLUSIONS
Although a higher TIMI risk score in patients with unstable angina or non-ST-elevation myocardial infarction who were undergoing percutaneous coronary intervention correlated with adverse clinical outcome, the score alone cannot be used to guide diagnostic or therapeutic strategies.
Kini
Annapoorna S
AS
Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029, USA.
Lee
Paul C
PC
Mitre
Cristina A
CA
Kim
Michael C
MC
Kamran
Mazullah
M
Duffy
Mary E
ME
Marmur
Jonathan D
JD
Sharma
Samin K
SK
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007527:Isoenzymes / Q000097:blood; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D013577:Syndrome; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D007527:Isoenzymes; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form