TIMI Risk Score: An outdated risk prediction tool for acute coronary syndrome?

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Rangel I (Author) Other; Sousa C (Author) Other; Gonçalves JP (Author) Other; Oliveira S (Author) Other; Lebreiro A (Author) Other; Sousa A (Author) Other; Correia AS (Author) Other; Paiva M (Author) Other; Ribeiro V (Author) Other; Melão F (Author) Other; Lopes C (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P949

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Background: TIMI risk score is a risk prediction tool for ST and non-ST elevation acute coronary syndrome (STEMI and NSTEMI, respectively), created in the trombolytic era. The exploded invasive management of all types of acute coronary syndrome (ACS) can make these scores outdated. The aim of this study was to assess the usefulness of TIMI score in ACS patients. Methods: Between February and August 2010, 240 ACS patients (135 NSTEMI and 105 STEMI) were admitted on our Coronary Care Unit. The patients were divided into three risk groups, namely low-risk, moderate-risk and high-risk based on their TIMI scores (NSTEMI: 0--2 low-risk, 3-4 moderate-risk, 5-7 high risk; STEMI: 0--4 low-risk, 5--8 moderate-risk, 9--14 high risk). Clinical characteristics and management were analysed, as well as, 14-day and 30-day mortality, myocardial infartion (MI) or urgent revascularization (UR). The frequencies of complications were also compared among the three risk groups. Results: From the 240 patients included, 70% were male, mean age 63 (13). Coronary angiography was performed in 89% of the patients and 64% of them undergone angioplasty. Assessing the TIMI score, NSTEMI patients had a median score of 3.0 points and 33% were classified as low-risk, 47% as intermediate and 20% as high-risk. Composite endpoint of 14-day mortality, new MI and UR was lower than the expected, according to the TIMI score (3% vs 13%, p<0.001). STEMI patients had a median score of 3.0 points and 61% were classified as low-risk, 36% as intermediate and 3% as high-risk. Thirty-day mortality, in STEMI patients, was also lower than expected (0% vs 4%, p=0.025). Moderate-high risk NSTEMI patients had more multivessel disease (48% vs 28%, P=0.032), myocardial dysfunction (48% vs 12%, P<0.001) and renal insufficiency (50% vs 19%, P=0.001). Moderate-high risk STEMI patients were also associated with renal insufficiency (36% vs 0%, P=0.003), but not myocardial dysfunction or multivessel disease. A moderate-high risk pontuation was a predictor of these outcomes in NSTEMI patients: multivessel disease (OR=2.4, p=0.044), myocardial dysfunction (OR=4.3, p=0.001) and renal insufficiency (OR=6.6, P<0.001). For both population groups, moderate-high risk was not strongly linked to a higher rate of mechanical and arrhythmic complications rate (p>0.05 for all the variables). Conclusion: In this population, mortality was lower than the expected, according to TIMI score, for both types of ACS. Although this risk score can help predicting some severity features in ACS, it is outdated and inadequate for clinical application in the invasive era.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Sousa C, Gonçalves JP, Oliveira S, Lebreiro A, Sousa A, Correia AS, Paiva M, Ribeiro V, Melão F, Lopes C, Maciel MJ. TIMI Risk Score: An outdated risk prediction tool for acute coronary syndrome? Eur J Heart Fail Suppl 2012; 11(Suppl 1): P949. ISSN 1567-4215 (Print) ISSN 1878-1314 (Online). Heart Failure Congress 2012, Belgrade, 2012