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Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome

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Abstract

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 ≥65 years, ST segment deviation ≥0.5 mm elevated troponin I, and coronary stenosis ≥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.

Conclusion

A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.

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Abbreviations

ACS:

Acute coronary syndrome

ED:

Emergency department

TIMI:

Thrombolysis in Myocardial Infarction

AMI:

Acute myocardial infarction

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Acknowledgments

None of the authors have any financial support or any conflict of interest in this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA

    Zehra Jaffery

  2. Henry Ford Heart and Vascular Institute, Detroit, MI, USA

    Michael P. Hudson & James McCord

  3. Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA

    Richard Nowak

  4. Department of Biostatistics, Henry Ford Hospital, Detroit, MI, USA

    Gordon Jacobsen

Authors
  1. Zehra Jaffery
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  2. Michael P. Hudson
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  3. Gordon Jacobsen
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  4. Richard Nowak
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  5. James McCord
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Corresponding author

Correspondence to Zehra Jaffery.

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Jaffery, Z., Hudson, M.P., Jacobsen, G. et al. Modified Thrombolysis in Myocardial Infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome. J Thromb Thrombolysis 24, 137–144 (2007). https://doi.org/10.1007/s11239-007-0013-0

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  • DOI: https://doi.org/10.1007/s11239-007-0013-0

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