title: Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty.
abstract: BACKGROUND
  Randomized trials comparing fibrinolysis with primary angioplasty for acute ST-elevation myocardial infarction have demonstrated a beneficial effect of primary angioplasty on the combined end point of death, reinfarction, and disabling stroke but not on all-cause death. Identifying a patient group with reduced mortality from an invasive strategy would be important for early triage. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a simple validated integer score that makes it possible to identify high-risk patients on admission to hospital. We hypothesized that a high-risk group might have a reduced mortality with an invasive strategy.
  
  
  RESULTS
  We classified 1527 patients from the Danish Multicenter Randomized Study on Fibrinolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction (DANAMI-2) trial with information for all variables necessary for calculating the TIMI risk score as low risk (TIMI risk score, 0 to 4) or high risk (TIMI risk score > or =5) and investigated the effect of primary angioplasty versus fibrinolysis on mortality and morbidity in the 2 groups. Follow-up was 3 years. We classified 1134 patients as low risk and 393 as high risk. There was a significant interaction between risk status and effect of primary angioplasty (P=0.008). In the low-risk group, there was no difference in mortality (primary angioplasty, 8.0%; fibrinolysis, 5.6%; P=0.11); in the high-risk group, there was a significant reduction in mortality with primary angioplasty (25.3% versus 36.2%; P=0.02).
  
  
  CONCLUSIONS
  Risk stratification at admission based on the TIMI risk score identifies a group of high-risk patients who have a significantly reduced mortality with an invasive strategy of primary angioplasty.
authors.affiliation: Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark. jjt@heart.dk
authors.forename: Jens Jakob
authors.initials: JJ
authors.lastname: Thune
authors.forename: Dan Eik
authors.initials: DE
authors.lastname: Hoefsten
authors.forename: Matias Greve
authors.initials: MG
authors.lastname: Lindholm
authors.forename: Leif Spange
authors.initials: LS
authors.lastname: Mortensen
authors.forename: Henning Rud
authors.initials: HR
authors.lastname: Andersen
authors.forename: Torsten Toftegaard
authors.initials: TT
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbaek
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000188:drug therapy; D010343:Patient Admission; D010361:Patients; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality