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Diagnostic Performance of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score in Predicting Angiographic
Ayesha Khaqan1, Aqeel Asghar2, Somia Pervaiz3
1Cardiology, King Fahad Medical City, Riyadh, SAU.
Insights
The Thrombolysis in Myocardial Infarction (TIMI) risk score shows moderate accuracy in predicting three-vessel disease (TVD) in non-ST-elevation myocardial infarction (NSTEMI) patients. While useful for screening, it cannot replace coronary angiography for definitive diagnosis.
Area of Science:
- Cardiology
- Diagnostic Accuracy
- Medical Risk Assessment
Background:
- Non-ST-segment elevation myocardial infarction (NSTEMI) frequently co-occurs with three-vessel disease (TVD).
- The Thrombolysis in Myocardial Infarction (TIMI) risk score is widely used for risk stratification in NSTEMI patients.
- Uncertainty exists regarding the TIMI score's diagnostic accuracy for predicting TVD.
Purpose of the Study:
- To evaluate the diagnostic performance of the TIMI risk score in identifying TVD among NSTEMI patients.
- To compare TIMI score predictions against coronary angiography as the gold standard.
Main Methods:
- A cross-sectional study included 185 NSTEMI patients.
- TIMI risk scores were calculated upon admission.
- Coronary angiography was performed to confirm TVD.
- Diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed.
Main Results:
- The study cohort had a mean age of 62.78 years, with 70.3% males.
- TVD was confirmed in 85.4% of patients via angiography.
- A TIMI score > 4 yielded a sensitivity of 71.5%, specificity of 66.7%, PPV of 92.6%, and NPV of 28.6%.
- Higher TIMI scores were significantly associated with TVD, male sex, diabetes, and urban residency.
Conclusions:
- The TIMI score exhibits moderate diagnostic performance for TVD in NSTEMI patients.
- The score demonstrates a high positive predictive value but a low negative predictive value.
- It may serve as a preliminary screening tool but does not replace coronary angiography for definitive diagnosis.
Abstract:
Background Patients with non-ST-segment elevation myocardial infarction (NSTEMI) often have three vessel disease (TVD). The Thrombolysis in Myocardial Infarction (TIMI) risk score is a commonly used bedside tool for risk stratification; however, its diagnostic accuracy for predicting TVD remains uncertain. Therefore, this study was conducted to assess the diagnostic performance of the TIMI score in the prediction of TVD among patients with NSTEMI with coronary angiography as the reference standard. Material and methods A total of 185 patients with NSTEMI were included in this cross-sectional study. TIMI risk scores were assessed on admission, and the patients underwent coronary angiography. Diagnostic performance was then evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The mean age of the cohort was 62.78±9.29 years, and 70.3% were male patients. TVD was angiographically validated in 85.4% of patients. Using a TIMI score > 4, the sensitivity was 71.5%, specificity 66.7%, PPV 92.6%, and NPV 28.6%. Post hoc analysis revealed significantly higher TIMI scores in patients with TVD (p<0.001), male patients (p=0.032), diabetics (p=0.041), and urban residents (p=0.028). Conclusion The TIMI score demonstrates moderate diagnostic performance for predicting TVD in patients with NSTEMI, with high PPV but low NPV. It could be a useful preliminary screening method; however, it cannot substitute angiography for a final, definite diagnosis.
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