Study of in-hospital outcome in acute myocardial infarction in correlation with thrombolysis in myocardial infarction risk score (original) (raw)
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Mortality of Acute Myocardial Infarction in Relation with Timi Risk Score
International Journal of Advanced Research, 2021
Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score is said to be an important factor in predicting mortality risk in fibrinolysis-eligible STEMI patients. An attempt was made to assess the situation by comparing risk stratification based on the TIMI score with the hospital outcome of such individuals. Methods: 145 STEMI patients were included in this srudy , TIMI risk scores were calculated and analysed vis-Ã -vis various relevant parameters.. Based on their TIMI scores, the patients were placed into three risk groups: low-risk,moderate-risk, and high-risk. All patients received standard anti-ischemic medication, were thrombolyzed, monitored in the ICCU, and monitored throughout their hospital stay for post-MI sequelae. Results: According to the TIMI risk score, 79 patients (54.5%) had low-risk , 48 (33.1%) to the moderate-risk , and 18 (12.4%) to the high-risk . The highest mortality rate (total 17 deaths) was found in the high-risk group (55.6%), followed by m...
2009
BACKGROUND Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. OBJECTIVES To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. METHODS The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low-risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complicati...
2010
We sought to evaluate a simple risk index based on age and vital signs in a community sample of patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND A simple risk index based on age and vital signs (heart rate ϫ [age/10] 2 /systolic blood pressure) developed from patients with STEMI accurately predicts mortality in clinical trials of fibrinolysis. The application of such a tool in an unselected population is necessary to evaluate its utility in clinical practice. METHODS To evaluate the Thrombolysis In Myocardial Infarction (TIMI) risk index for routine practice, we tested it in the National Registry of Myocardial Infarction (NRMI)-3 and-4. The risk index was evaluated as a continuous variable in patients with STEMI from NRMI and in subgroups based on age and reperfusion status. RESULTS A total of 153,486 patients with STEMI were eligible. As anticipated, STEMI patients in NRMI had a higher risk index profile, as compared with those in the clinical trial (median 26.9 vs. 20, p Ͻ 0.0001). Classification of NRMI patients with STEMI into risk groups revealed a significant graded relationship with mortality (0.9% to 53.2%, p trend Ͻ 0.0001, c statistic 0.79). The discriminatory capacity of the risk index was particularly strong in the 81,679 patients receiving reperfusion therapy (0.6% to 60%, p trend Ͻ 0.0001, c statistic 0.81). For the 71,807 patients not receiving reperfusion therapy, a strong graded relationship remained (1.9% to 52.2%, p trend Ͻ 0.0001, c statistic 0.71). Among the elderly, although the distribution of scores was shifted toward higher risk, the performance remained (0% to 53.1%, p trend Ͻ 0.0001, c statistic 0.71). CONCLUSIONS A simple risk index from baseline clinical variables routinely obtained at the first patient encounter predicted mortality in a large unselected heterogeneous group of patients with STEMI.
Journal of the American College of Cardiology, 2006
The purpose of this research was to evaluate the Thrombolysis In Myocardial Infarction risk index (TRI) to characterize the risk of death among patients with non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND The TRI, calculated from baseline age, systolic pressure, and heart rate, was established in patients with ST-segment elevation myocardial infarction (STEMI) and is predictive of mortality. Patients presenting with NSTEMI are increasing compared to STEMI and constitute a group with varied risk. METHODS The TRI was calculated in 337,192 patients from the National Registry of Myocardial Infarction with NSTEMI. Values and outcomes were compared with 153,486 patients with STEMI classified by reperfusion status. Comparisons of baseline characteristics and clinical outcomes stratified by TRI were made. RESULTS There was a graded relationship between the TRI and mortality in patients with NSTEMI with a Ͼ30-fold difference in mortality rates between lowest and highest deciles (p Ͻ 0.0001). The index showed good discrimination (c ϭ 0.73). Overall mortality in the group with NSTEMI was higher (10.9%) than patients with STEMI treated with (6.6%) but lower than for STEMI patients not receiving reperfusion therapy (18.7%). The higher risk in comparison to patients with STEMI treated with reperfusion therapy was explained largely by the higher-risk profile of the population with NSTEMI. CONCLUSIONS There is a graded relationship between TRI and mortality in patients with NSTEMI. This simple risk index provides important information about mortality in patients across the spectrum of myocardial infarction, STEMI and NSTEMI. Early identification of NSTEMI patients who are at high risk of in-hospital mortality may provide clinicians with important information for initial triage and treatment.
2009
Background TIMI (Thrombolysis in Myocardial Infarction) Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in patients with ST-elevation myocardial infarction (MI). We sought to evaluate whether TRI was predictive of longterm mortality and clinical events. Methods In the TIMI 2 trial, 3,153 patients (mean age 57 ± 10 years, 82% men) were randomized to invasive (n = 1,583) versus conservative (n = 1,570) strategy postfibrinolysis with median follow-up of 3 years. TIMI Risk Index was divided into 5 groups. The primary end point was all-cause mortality. Secondary analyses included recurrent MI, congestive heart failure (CHF), and combined end points. Results When compared with group 1, mortality in group 5 was more than 5-fold higher (hazard ratio [HR] 5.83, P b .0001) and was also increased in group 4 (HR 2.80, P b .0001) and group 3 (HR 1.96, P = .002) (c statistic 0.69). No difference was seen between groups 1 and 2 (P = .74). A similar increasing gradient effect was seen across TRI strata with group 5 having the highest risk for CHF (HR 4.13, P b .0001) and the highest risk for composite death/CHF (HR 4.35, P b .0001) over group 1. There was no difference in recurrent MI between the groups (P = .22). After controlling for other risk indicators, the relationship between TRI and mortality remained significant: group 5, HR 4.11, P b .0001; group 4, HR 2.14, P = .0009; group 3, HR 1.69, P = .02. When stratified by TRI groups, no differences in mortality or composite death/MI were found between treatment strategies. Conclusions The simple TRI can predict increased long-term mortality, CHF, and composite death/CHF.
Thrombolysis in Myocardial Infarction Risk Score in an Observation Unit Setting
Critical Pathways in Cardiology, 2013
Objective: The Thrombolysis in Myocardial Infarction (TIMI) score is a validated tool for risk stratification of acute coronary syndrome. We hypothesized that the TIMI risk score would be able to risk stratify patients in observation unit for acute coronary syndrome. Methods: Study design: Retrospective cohort study of consecutive adult patients placed in an urban academic hospital emergency department observation unit with an average annual census of 65,000 between 2004 and 2007. Exclusion criteria included elevated initial cardiac biomarkers, ST segment changes on ECG, unstable vital signs, or unstable arrhythmias. A composite of significant coronary artery disease (CAD) indicators, including diagnosis of myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, or death within 30 days and 1 year, were abstracted via chart review and financial record query. The entire cohort was stratified by TIMI risk scores (0-7) and composite event rates with 95% confidence interval were calculated. Results: In total 2228 patients were analyzed. Average age was 54.5 years, 42.0% were male. The overall median TIMI risk score was 1. Eighty (3.6%) patients had 30-day and 119 (5.3%) had 1-year CAD indicators. There was a trend toward increasing rate of composite CAD indicators at 30 days and 1 year with increasing TIMI score, ranging from a 1.2% event rate at 30 days and 1.9% at 1 year for TIMI score of 0 and 12.5% at 30 days and 21.4% at 1 year for TIMI ≥4. Conclusions: In an observation unit cohort, the TIMI risk score is able to risk stratify patients into low-, moderate-, and high-risk groups.
Cardiovascular Journal, 2018
Background: The Thrombolysis In Myocardial Infarction (TIMI) risk score was developed as a bedside tool to stratify STEMI patients eligible for reperfusion by their mortality risk. The TIMI risk score has shown to provide good discrimination in predicting mortality at 30 days and even up to 365 days.Methods: By purposive sampling a total of 64 consecutive patients were considered. Coronary artery disease severity was assessed by Vessels Score. The in-hospital adverse outcomes looked for were heart failure, cardiogenic shock, ventricular arrhythmia, re-infarction, stroke and death. Study subject was divided into two groups on the basis of TIMI risk score. In group I - patients with low TIMI risk score (0- 4); in group II - Patients with high TIMI risk score (≥5).Results: Multi vessel involvement were less in low TIMI group 1 (3.1%) but much greater (p<0.05) in high TIMI group 9 (28.1%). Adverse outcome was present 10(31.3%) in high TIMI group and 2(6.3%) in low TIMI group (p=0.01)...