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Updated: Aug 21, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Sequential risk stratification using TIMI risk score and TIMI flow grade among patients treated with fibrinolytic
Dimitrios Karmpaliotis1, Minang P Turakhia, Ajay J Kirtane
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Insights
The Thrombolysis In Myocardial Infarction (TIMI) risk score (TRS) predicts mortality in ST-elevation myocardial infarction (STEMI). Impaired blood flow and myocardial perfusion after treatment are independently linked to higher mortality, especially in high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) carries significant mortality risk.
- The Thrombolysis In Myocardial Infarction (TIMI) risk score (TRS) and perfusion indexes predict outcomes.
- The relationship between baseline TRS and post-reperfusion perfusion is not well-established.
Purpose of the Study:
- To investigate the association between baseline TIMI risk score (TRS) and angiographic indexes of epicardial and myocardial perfusion after reperfusion therapy.
- To determine if TRS, TIMI flow grade (TFG), and TIMI myocardial perfusion grade (TMPG) provide independent prognostic information.
- To assess if poor perfusion is associated with a higher baseline TRS.
Main Methods:
- Analysis of 3,801 patients from multiple TIMI trials.
- Evaluation of baseline TRS and post-reperfusion TFG and TMPG.
- Multivariate logistic regression models to assess independent associations with mortality and risk stratification.
Main Results:
- Mortality increased stepwise with impaired TFG within each TRS stratum.
- Impaired TMPG (grades 0/1) was independently associated with higher 30-day mortality (OR 2.28, p=0.018).
- Higher baseline TRS (intermediate and high risk) was associated with a greater likelihood of impaired TMPG (OR 1.43-1.50).
Conclusions:
- Impaired epicardial flow and myocardial perfusion are independently associated with increased 30-day mortality in STEMI patients.
- High baseline TRS is linked to abnormal myocardial perfusion post-reperfusion.
- No synergistic effect was observed between perfusion grades and TRS on mortality.
Abstract:
In the setting of ST-segment elevation myocardial infarction (STEMI), the Thrombolysis In Myocardial Infarction (TIMI) risk score (TRS) and indexes of epicardial and myocardial perfusion are associated with mortality. The association between TRS at presentation and angiographic indexes of epicardial and myocardial perfusion after reperfusion therapy has not been investigated. We hypothesized that TRS, TIMI flow grade (TFG), and TIMI myocardial perfusion grade (TMPG) would provide independent prognostic information and that angiographic indexes of poor flow and perfusion would be associated with a higher TRS. TRS and angiographic data were evaluated in 3,801 patients from the TIMI 4, 10A, 10B, 14, 20, 23, and 24 trials. Within each TRS stratum (TRS 0 to 2, 3 to 4, >/=5), 30-day mortality increased stepwise among patients with impaired TFG at 60 minutes after fibrinolytic administration. In a multivariate model adjusting for the TRS strata, impaired TMPG (0/1) was independently associated with higher mortality (odds ratio 2.28, p = 0.018). In a multivariate model adjusting for the TFG and infarct location, the likelihood of impaired TMPG (0/1) was greater among intermediate-risk (TRS 3 to 4) and high-risk (TRS >/=5) patients than among low-risk (TRS 0 to 2) patients (odds ratio 1.43, p = 0.019 and 1.50, p = 0.055, respectively). Thus, impaired epicardial flow and myocardial perfusion are independently associated with increased 30-day mortality among patients identified by TRS as high risk, although there is no synergism between either TFG or TMPG and TRS. High TRS at presentation is associated with abnormal myocardial perfusion, even after adjusting for possible confounders.
