Application of the TIMI risk score in ED patients with cocaine-associated chest pain.
OBJECTIVE
The TIMI risk score has been validated as a risk stratification tool in emergency department (ED) patients with potential acute coronary syndrome. The goal of this study was to assess its ability to predict adverse cardiovascular outcomes in cocaine-associated chest pain.


METHODS
This was a prospective cohort study of ED patients with chest pain with cocaine use. Data included demographics, medical history, and TIMI risk score. The main outcomes were acute myocardial infarction, revascularization, or death within 30 days of ED presentation.


RESULTS
There were 261 patient visits. Patients were 43.2+8 years old, 73% male, 92% black, and 75% smokers. There were 33 patients with the composite outcome. The incidence of 30-day outcomes according to TIMI score is as follows: TIMI 0, 3.7% (95% CI, 0.1-8.3); TIMI 1, 13.2% (5.7-20.7); TIMI 2, 17.1% (4.3-29.8); TIMI 3, 21.4% (4.4-38.4); TIMI 4, 20.0% (0.1-43.6); TIMI 5/6, 50.0% (0.1-100).


CONCLUSIONS
The TIMI risk score has no clinically useful predictive value in patients with cocaine-associated chest pain.
Chase
Maureen
M
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. mchase1@bidmc.harvard.edu
Brown
Aaron M
AM
Robey
Jennifer L
JL
Zogby
Kara E
KE
Shofer
Frances S
FS
Chmielewski
Lauren
L
Hollander
Judd E
JE
D000328:Adult; D002637:Chest Pain / Q000139:chemically induced*; D016009:Chi-Square Distribution; D019970:Cocaine-Related Disorders / Q000150:complications*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors