title: Prospective validation of Thrombolysis in Myocardial Infarction and front door Thrombolysis in Myocardial Infarction risk scores in Chinese patients presenting to the ED with chest pain.
abstract: BACKGROUND
  Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction (TIMI) and front door TIMI (FDTIMI) scores are used to risk stratify chest pain patients in many Western countries; they have not been validated in patients with undifferentiated chest pain in Asia. Our objective was to establish the relationship between the TIMI and FDTIMI scores and the 30 day rate of major adverse cardiac outcomes (MACE) in Chinese patients presenting to the ED with chest pain.
  
  
  METHODS
  Prospective, single-center, observational cohort study of consecutive patients presenting with chest pain from July 2009 until March 2010 to a Hong Kong university hospital ED. Data collected included patient characteristics, TIMI items and past medical and medication history. Primary outcome was MACE within 30 days of presentation. MACE was a composite outcome of any of the following: death (all causes), readmission with myocardial infarction, acute coronary syndrome not diagnosed at initial ED presentation and coronary revascularization.
  
  
  RESULTS
  One thousand patients recruited with complete 30-day follow-up. STEMI patients (n = 75) were excluded. Mean patient age 66.8 ± 13.9 years; 51.7% male. 119 (12.9%) patients had MACE within 30 days of presentation. The incidence of MACE ranged from 0 for TIMI0 to 37.5% for patients with TIMI6/7. Increasing TIMI and FDTIMI scores were associated with a higher incidence of MACE.
  
  
  CONCLUSIONS
  This validation suggests that the TIMI/FDTIMI scores can be employed in Hong Kong Chinese; they may be useful for risk stratification of Chinese ED patients with undifferentiated chest pain elsewhere.
authors.affiliation: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR. Electronic address: cagraham@cuhk.edu.hk.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.affiliation: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
authors.forename: Jannet W M
authors.initials: JW
authors.lastname: Chan
authors.affiliation: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
authors.forename: Cangel P Y
authors.initials: CP
authors.lastname: Chan
authors.affiliation: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
authors.forename: Giles N
authors.initials: GN
authors.lastname: Cattermole
authors.affiliation: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000379:methods*; D061665:Time-to-Treatment; D016896:Treatment Outcome