Modified thrombolysis in myocardial infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome.
OBJECTIVE
To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS).


BACKGROUND
The ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain.


METHODS
We investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization).


RESULTS
There were 151 (16%) patients diagnosed with ACS. At 30 days there were 48 (5%) deaths, 84 (9%) myocardial infarctions, and 49 (5%) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 +/- 1.3 vs. 1.7 +/- 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age > or = 65 years, ST segment deviation > or = 0.5 mm elevated troponin I, and coronary stenosis > or = 50%) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score.


CONCLUSIONS
A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.
Jaffery
Zehra
Z
Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA. zjaffer1@hfhs.org
Hudson
Michael P
MP
Jacobsen
Gordon
G
Nowak
Richard
R
McCord
James
J
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D000368:Aged; D002637:Chest Pain; D023921:Coronary Stenosis; D003643:Death; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D019210:Troponin I / Q000097:blood
D019210:Troponin I