Validity of TIMI Risk Score and HEART Score for Risk Assessment of Patients with Unstable Angina/Non-ST Elevation
Muhannad J Ababneh1, Mahmoud Mustafa Smadi2, Abdullah Al-Kasasbeh1
1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Insights
The Thrombolysis in Myocardial Infarction (TIMI) and HEART scores showed some ability to predict major adverse cardiovascular events in chest pain patients. However, the TIMI score tended to underestimate the actual risk observed in this Middle Eastern population.
Area of Science:
- Cardiology
- Emergency Medicine
- Risk Stratification
Background:
- Chest pain is a common emergency department presentation.
- Accurate risk assessment is crucial for managing patients with chest pain.
- The applicability of existing risk scores in diverse populations requires validation.
Purpose of the Study:
- To evaluate the validity and predictability of the Thrombolysis in Myocardial Infarction (TIMI) risk score and the HEART score.
- To assess these scores in patients presenting with chest pain in Jordan, representing the Middle East and North Africa (MENA) region.
- To compare the predicted cardiovascular risk with actual clinical outcomes.
Main Methods:
- Prospective follow-up of 237 patients presenting to the emergency department with chest pain.
- Calculation of TIMI and HEART risk scores for all patients.
- Monitoring for percutaneous coronary intervention (PCI), major adverse cardiovascular events (MACE), and all-cause mortality.
Main Results:
- The study population predominantly consisted of patients with unstable angina (77%) and non-ST elevation myocardial infarction (NSTEMI) (23%).
- A significant proportion of patients had risk factors including smoking, hypertension, and dyslipidemia.
- The TIMI risk score underestimated the observed event rate, with patients scoring 3-5 experiencing a 5-8% higher event rate than predicted.
Conclusions:
- Both TIMI and HEART risk scores demonstrated an ability to predict elevated risk for major adverse cardiovascular events (MACE).
- The TIMI risk score appeared to underestimate the actual cardiovascular risk in this Jordanian patient cohort.
- Further validation of risk scores in MENA populations is warranted.
Purpose:
To examine the validity and predictability of thrombolysis in myocardial infarction (TIMI) risk and HEART scores in patients presenting to the emergency department (ED) with chest pain in Jordan (representative of the Middle East and North Africa Region, MENA).
Patients And Methods:
Risk scores were calculated for 237 patients presenting to the ED with chest pain. Patients were followed-up prospectively for the need for percutaneous coronary intervention, major adverse cardiovascular events, and all-cause mortality, looking for correlation and accuracy between the predicted cardiovascular risk from TIMI risk score and HEART score and the clinical outcome.
Results:
Of the 237 patients, approximately 77% were diagnosed with unstable angina and 23% diagnosed with non-ST elevation myocardial infarction (NSTEMI). about two thirds of the study population were smokers and known to have hypertension and dyslipidaemia. In 50 patients, the primary outcome (need for percutaneous coronary intervention (PCI) and/or major adverse cardiovascular events (MACE) at days 14 and 40, all-cause mortality) was observed. Regarding the predictability of the TIMI score, a larger number of events were observed in the study population than predicted. Patients with TIMI scores of 3 to 5 have about a 5-8% higher event rate than predicted.
Conclusion:
Both TIMI and HEART risk scores were able to predict an elevated risk of major cardiovascular adverse events (MACE). The overall impression was that the TIMI risk score tended to underestimate risk in the study population.
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