Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3
D A Morrow1, E M Antman, L Parsons
1Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. damorrow@bics.bwh.harvard.edu
Insights
The Thrombolysis in Myocardial Infarction (TIMI) risk score effectively predicts mortality in ST-elevation myocardial infarction (STEMI) patients, especially those receiving reperfusion therapy. Its bedside utility is confirmed in contemporary practice.
Area of Science:
- Cardiology
- Clinical Risk Assessment
- Public Health
Background:
- The Thrombolysis in Myocardial Infarction (TIMI) risk score is a bedside tool for assessing ST-elevation myocardial infarction (STEMI) risk.
- Previous validation was limited to fibrinolytic trials, necessitating evaluation in broader populations.
Purpose of the Study:
- To validate the TIMI risk score in a contemporary, community-based STEMI population.
- To assess its predictive accuracy for mortality.
Main Methods:
- The TIMI risk score was evaluated in 84,029 STEMI patients from the National Registry of Myocardial Infarction 3 (NRMI 3).
- Model discrimination (c-statistic) and calibration were used to assess predictive ability.
- Analysis included patients receiving reperfusion therapy and those who did not.
Main Results:
- The TIMI risk score demonstrated a significant graded increase in mortality with higher scores (1.1%-30.0%).
- Overall prognostic capacity was strong (c=0.74), comparable to the derivation set (c=0.78).
- The score performed well in patients receiving reperfusion therapy (c=0.79) but underestimated risk in those not receiving therapy (c=0.65).
Conclusions:
- The TIMI risk score is practical for bedside risk assessment in STEMI patients.
- It is effective for triage and treatment decisions, particularly for patients receiving reperfusion therapy.
Context:
The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-elevation myocardial infarction (STEMI) is a simple integer score for bedside risk assessment of patients with STEMI. Developed and validated in multiple clinical trials of fibrinolysis, the risk score has not been validated in a community-based population.
Objective:
To validate the TIMI risk score in a population of STEMI patients reflective of contemporary practice.
Design, Setting, And Participants:
The risk score was evaluated among 84 029 patients with STEMI from the National Registry of Myocardial Infarction 3 (NRMI 3), which collected data on consecutive patients with myocardial infarction (MI) from 1529 US hospitals between April 1998 and June 2000.
Main Outcome Measures:
Ability of the TIMI risk score to correctly predict risk of death in terms of model discrimination (c statistic) and calibration (agreement of predicted and observed death rates).
Results:
Patients in NRMI 3 tended to be older, to be more often female, and to have a history of coronary disease more often than those in the derivation set. Forty-eight percent received reperfusion therapy. The TIMI risk score revealed a significant graded increase in mortality with rising score (range, 1.1%-30.0%; P<.001 for trend). The risk score showed strong prognostic capacity overall (c = 0.74 vs 0.78 in derivation set) and among patients receiving acute reperfusion therapy (c = 0.79). Predictive behavior of the risk score was similar between fibrinolytic-treated patients (n = 23 960; c = 0.79) and primary percutaneous coronary intervention patients (n = 15 348; c = 0.80). In contrast, among patients not receiving reperfusion therapy, the risk score underestimated death rates and offered lower discriminatory capacity (c = 0.65).
Conclusions:
Sufficiently simple to be practical at the bedside and effective for risk assessment across a spectrum of patients, the TIMI risk score may be useful in triage and treatment of patients with STEMI who are treated with reperfusion therapy.
More Related Videos
Related Concept Videos
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:19Mitral Valve Prolapse III: Nursing Management
01:25Mitral Regurgitation III: Medical Management
01:26Mitral Stenosis III: Medical Management
01:27Mitral Stenosis IV: Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies