title: The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing  primary angioplasty.
abstract: BACKGROUND
  Patients with ST elevation acute myocardial infarction (STEMI) comprise a heterogeneous population with respect to the risk for adverse events. Primary percutaneous coronary intervention (PCI) has shown to be better, mainly in high-risk patients.
  
  
  OBJECTIVE
  The purpose of this study was to determine if the Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI applied to patients undergo primary PCI identifies a group of patients at high risk for adverse events.
  
  
  METHODS
  We identified patients with STEMI without cardiogenic shock on admission, who were treated with primary PCI. The TIMI and CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) risk scores were calculated to determine their predictive value for in hospital mortality. Patients were divided into two groups according to their TIMI risk score, low risk being 0-4 points and high risk .5 points, and the frequency of adverse events was analyzed.
  
  
  RESULTS
  We analyzed 572 patients with STEMI. The c-statistics predictive value of the TIMI risk score for mortality was 0.80 (p=0.0001) and the CADILLAC risk score was 0.83, (p=0.0001). Thirty-two percent of patients classified as high risk (TIMI .5) had a higher incidence of adverse events than the low-risk group: mortality 14.8% vs. 2.1%, (p=0.0001); heart failure 15.3% vs. 4.1%, (p=0.0001); development of cardiogenic shock 10.9% vs. 1.5%, (p=0.0001); ventricular arrhythmias 14.8% vs. 5.9%, (p=0.001); and no-reflow phenomenon 22.4% vs. 13.6%, (p=0.01).
  
  
  CONCLUSIONS
  The TIMI risk score for STEMI prior to primary PCI can predict in hospital mortality and identifies a group of high-risk patients who might develop adverse events.
authors.affiliation: Coronary Care Unit. Instituto Nacional de Cardiología Ignacio Chávez. Mexico City. Mexico.
authors.forename: Héctor
authors.initials: H
authors.lastname: González-Pacheco
authors.forename: Alexandra
authors.initials: A
authors.lastname: Arias-Mendoza
authors.forename: Amada
authors.initials: A
authors.lastname: Álvarez-Sangabriel
authors.forename: Úrsulo
authors.initials: Ú
authors.lastname: Juárez-Herrera
authors.forename: Félix
authors.initials: F
authors.lastname: Damas
authors.forename: Guering
authors.initials: G
authors.lastname: Eid-Lidt
authors.forename: Francisco
authors.initials: F
authors.lastname: Azar-Manzur
authors.forename: Carlos
authors.initials: C
authors.lastname: Martínez-Sánchez
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D018570:Risk Assessment; D012770:Shock, Cardiogenic; D015912:Thrombolytic Therapy