Approach to stemi and nstemi lal c daga1, upendra kaul2, aijaz mansoor 3. One hundred and fiftysix patients were admitted with stemi and were classified by timi score. The timi risk score for uanstemi estimates mortality for patients with unstable angina and nonst elevation myocardial infarction mi. This score was developed based on thrombolytic outcomes, which likely have worse outcomes when compared to pci. Timi risk score was developed in a cohort of 146 male tunisian mean age 52. The timi risk score is an easy bedside calculation mostly based on the patients medical history and a few initial tests ecg and initial labs in patients presenting to the emergency department ed with unstable angina or nstemi when trying to assess their risk for cardiac related ischemic events and death within the first 14 days after presenting to the ed. The calculator thrombolysis in myocardial infarction timi score for st elevation acute myocardial infarction is used as a simple arithmetic sum of independent predictors of mortality. Timi risk score for unstable angina or nonst elevation mi.
In order to provide the result, this timi risk score for nstemi calculator sums the points and delivers a mortality risk percentage. Several variations from the classic stemi ecg changes are similarly concerning and considered stemi equivalent stemi equivalents posterior mi. The timi risk score for stemi predicts inhospital mortality and. The grace score and timi score were calculated automatically from the prospectively collected data, without interpretation by the investigators. Original article inhospital outcome of acute stsegment. Interestingly, the shortterm, inhospital risk score such as timi score is also useful in risk stratification for a longterm outcome. Dynamic timi risk score for stemi pubmed central pmc. Dynamic timi risk score for stemi for predicting 1. Stemi extensive anterior wall onset 4 hours killip i timi score 314 free download as powerpoint presentation. Timi risk score for stelevation myocardial infarction. Risk scores combine and weigh various predictors to calculate the risk of acs for an individual patient.
Pdf the timi risk score for unstable anginanonst elevation mi. The timi risk score for unstable anginanonst elevation. Stemi extensive anterior wall onset 4 hours killip i timi score 314. Timi risk score as a predictor for noreflow phenomenon in. Thrombolysis in myocardial infarction timi score for usa. Overall, the timi risk score showed a strong potential of predicting mortality in stemi patients, revealing a significant, nearly 30fold graded increase in risk between patients with a score of. The timi risk score for stemi may help a cardiology, medical andor intensive care team with weighing riskbenefit of medications like anticoagulation and invasive procedures by knowing a patients baseline risk. Prognostic value of timi score versus grace score in st. Acute coronary syndrome especially nstemi is a very often missed diagnosis in icu patients.
Ecg in stemi ecg is a mainstay in the initial diagnosis of patients with suspected acs which will dictate management in patients with acute stemi the ecg evolves through a typical sequence. Accordingly, we investigate the inhospital outcomes of patients with stemi treated with iabp counterpulsation according to different timi risk scores. Timi and grace are the risk scores that up until now have been most. In this study, the timi score is more reliable in predicting mortality in patient with stemi, compare with grace score. Thrombolysis in myocardial infarction timi score for st. After application of multivariate regression analysis, timi risk score of stemi was an independent predictors of noreflow phenomenon odds ratio 1. Application of the timi risk score for stelevation mi in the national registry of myocardial infarction 3 david a. Grace, timi for stemi, pursuit, sri, emmace, cacs, cha2ds2vaschs, action registrygwtg and. The timi score identified no low risk patients at this safety level. Methods of prognostication that merge these populations do not take advantage of important information gathered in the first few days following.
Dynamic timi risk score for stemi journal of the american heart. Conclusions ua and nstemi patients have varied anatomy and pathology need to be stratified to determine urgency and modality of treatment either invasive or conservative simple bed side score like timi score can stratify patients. Statistical analysis was performed with oneway anova with the tukey post test and pearson correlation. The timi risk score for nsteacs characteristics 34 indicates intermediate risk, where as score of 57 is high risk. A method for prognostication and therapeutic decision making. One of the key roles of these risk scores is to identify patients at low risk for mace. Application of risks scores in acute coronary syndromes. Findings present in at least 2 anatomically contiguous leads.
Risk scores combine and weigh various predictors to. With respect to double vessel disease the findings of our study are quite similar to gracia et al as they reported that 116 patients had two vessel disease. Timi risk score for ua and nonstemi antman em et al. An intravenous npa for treatment of infarcting myocardium early ii trial substudy. After this verification of the discrimination of the baseline score, 10 variables reflecting events during the index hospitalization were considered for inclusion in the dynamic timi risk score for stemi table 2. The heart score was calculated by physicians at the moment of admission at the ed during the heart care period. Our results suggest that the timi risk score may be a reliable predictor of a poor outcome mace during the shortterm observation of patients with apns. The first step in the management of the patient with an acute stelevation myocardial infarction stemi is prompt recognition, since the beneficial effects of therapy with reperfusion are greatest when performed soon after presentation. Ecg in stemi definition of stemi new st elevation at.
Comparison of the grace, heart and timi score to predict. A timi risk score of 0 or 1 does not equal zero risk of adverse outcome. Derivation and validation study derived from thrombolysis in myocardial infarction timi 11b. Use of the timi score to risk stratify acute coronary syndrome patients. In patients with uanstemi, the timi risk score is a simple prognostication scheme that categorizes a patients risk of death and ischemic events and provides a basis for therapeutic decision making. The dynamic timi risk score has a high discriminatory capacity, with a c. Timi risk score predicts death in stemi patients medscape. A timi score general, patients having multiple coronary risk factors, advanced age, rest angina, clinical left ventricular lv dysfunction, prior history of percutaneous coronary intervention. The timi risk score for stemi was assessed in an external data set from the timi 9 trial.
Timi risk score for stemi is a simple assessment based on clinical data at the time of patient arrival at the hospital. I the thrombolysis in myocardial infarction timi risk score for stelevation myocardial infarction stemi is a 8 items scoring system developed to predict the risk of death from any cause at 30 days in patients with stemi. The presentation addresses emergenc slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In addition, using a merged database of the timi 11b and essence studies, testing for a heterogeneous treatment effect stratified by risk score. It comprises of 7 factors that are evaluated through a simple questionnaire, each of the answers being given a certain amount of points. The parameters for the calculator include age, cad risk factors, aspirin. Patients with st elevation acute myocardial infarction stemi comprise a he terogeneous population with respect to the risk for adverse events.
Timi risk score of stemi on admission can predict angiographic noreflow phenomenon after primary pci. This distinguishes the timi risk score from other scoring systems that are more complex computationally since they require weighting terms for the predictor variables and cannot be implemented easily without computer assistance. Where the st segment and t wave merge, the shape should be concave, as indicated in the diagram to. The timi risk score at ed presentation successfully riskstrati. However, there are several other known rs, such as. Conclusions in patients with uanstemi, the timi risk score is a simple prognos tication scheme. Comparison of the grace, heart and timi score to predict major. For patients presenting to the emergency department with chest pain suspicious for an acute coronary. Prior aspirin use and outcomes in acute coronary syndromes core. Effects of prior aspirin and antiischemic therapy on outcome of patients with unstable angina. In patients with uanstemi, the timi risk score is a simple prognostication. From july 2004 to december 2006, the data of 359 patients with acs were collected prospectively.
Stemi patients should obviously undergo pci or thrombolysis, depending on availability and standard of care at ones hospital. Timi risk score for stemi the timi risk score for stemi figure 2 showed a strong association with mortality at 30 days, with a. The timi study group has been an academic research organization dedicated to advancing the knowledge and care of patients suffering from cardiovascular disease. Timi risk score for secondary prevention trs 2p timi risk score for hf in diabetes trshfdm bmi. In brief, this score consists of eight dichotomic variables, with the exception of. Pdf patients with unstable anginanonstsegment elevation myocardial infarction. Th e increase in timi risk score per one unit increased the risk of a poor outcome by 54%. Creatinine clearance cockcroft gault equation gfr calculators. A convenient, bedside, clinical score for risk assessment at presentation.
The maximum possible risk score is 14 points and the minimum 0. Pdf timi, grace and alternative risk scores in acute coronary. It is the dedication of healthcare workers that will lead us through this crisis. The calculator thrombolysis in myocardial infarction timi score for unstable angina non st elevation myocardial infarction is used to guide patient care in unstable angina. The timi risk score for unstable anginanonst elevation mi. Emergency department assessment of chest pain score edacs. N refers to the number of patients falling under that score category, whereas % refers. In the belgian stemi registry, ppcitreated women had a higher inhospital mortality rate even after correcting for timi risk score variables. It is a tool that differentiates nonstemi from stemi ischemic events. Pdf acute coronary syndromes acs represent a difficult challenge for physicians. When a patient presents with an acute stemi, the optimal treatment is usually clear proceed to pci immediately. The parameters for the calculator include dm, history of htn or angina, systolic blood pressure, heart rate, killip class iiiv, body weight, anterior lead st elevation of left bbb, time to treat, age. The cox model for death using the baseline timi risk score had a c.
Pdf dynamic timi risk score for stemi researchgate. Timi 9a and 9b were multicenter randomized trials evaluating the safety and efficacy of hirudin as an adjunct to fibrinolytic therapy tissue plasminogen activator or. Approach to stemi and nstemi journal of association of. Application of the timi risk score for stelevation mi in. The timi score was created and validated in a sample of patients with stsegment elevation myocardial infarction, and thus, has specific variables for this clinical condition.
Whereas the baseline timi risk score for stemi has 0 to 14 possible points, the dynamic timi risk score has a total of 0 to 29 possible points, with 0 to 15 points assigned based on in. Troponin and timi risk score were positively correlated. I in patients with uanstemi, this timi risk score is a simple prognostication scheme that categorizes the risk of death and ischemic events and provides a basis for therapeutic decision making. Patients with stemi, who had not been previously treated with thrombolysis, and those who had been undergone to an unsuccessful thrombolysis, as well as patients with nstemi with a timi score 3 who were immediately referred to the cat lab and whenever possible treated with ptca. Barron, md eugene braunwald, md e ffective risk stratification is integral. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Application of the timi risk score for unstable angina and. The highest correlation of an individual timi risk indicator to adverse outcome was for. Timi risk score11 has been validated and can be used. Stemi extensive anterior wall onset 4 hours killip i timi. Reynolds cad risk timi risk score stemi valiant heart failure risk score grace the grace acs risk calculator estimates risk of death following acute coronary syndrome acs pretest probability of cad cad consortium determine pretest probability of coronary artery disease in patients with chest pain.
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