title: Dynamic TIMI risk score for STEMI.
abstract: BACKGROUND
  Although there are multiple methods of risk stratification for ST-elevation myocardial infarction (STEMI), this study presents a prospectively validated method for reclassification of patients based on in-hospital events. A dynamic risk score provides an initial risk stratification and reassessment at discharge.
  
  
  RESULTS
  The dynamic TIMI risk score for STEMI was derived in ExTRACT-TIMI 25 and validated in TRITON-TIMI 38. Baseline variables were from the original TIMI risk score for STEMI. New variables were major clinical events occurring during the index hospitalization. Each variable was tested individually in a univariate Cox proportional hazards regression. Variables with P<0.05 were incorporated into a full multivariable Cox model to assess the risk of death at 1 year. Each variable was assigned an integer value based on the odds ratio, and the final score was the sum of these values. The dynamic score included the development of in-hospital MI, arrhythmia, major bleed, stroke, congestive heart failure, recurrent ischemia, and renal failure. The C-statistic produced by the dynamic score in the derivation database was 0.76, with a net reclassification improvement (NRI) of 0.33 (P<0.0001) from the inclusion of dynamic events to the original TIMI risk score. In the validation database, the C-statistic was 0.81, with a NRI of 0.35 (P=0.01).
  
  
  CONCLUSIONS
  This score is a prospectively derived, validated means of estimating 1-year mortality of STEMI at hospital discharge and can serve as a clinically useful tool. By incorporating events during the index hospitalization, it can better define risk and help to guide treatment decisions.
authors.affiliation: Department of Cardiology, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Sameer T
authors.initials: ST
authors.lastname: Amin
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: Sarah
authors.initials: S
authors.lastname: Sloan
authors.forename: Charles
authors.initials: C
authors.lastname: Contant
authors.forename: Sabina
authors.initials: S
authors.lastname: Murphy
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016017:Odds Ratio; D010351:Patient Discharge; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome