Document Detail


Prognostic value of the Thrombolysis in Myocardial Infarction risk score in a unselected population with chest pain. Construction of a new predictive model.
MedLine Citation:
PMID:  18410812     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The Thrombolysis in Myocardial Infarction (TIMI) risk score (TRS) has proven to be a useful and simple tool for risk stratification of patients with chest pain in intermediate- and high-risk populations. There is little information on its applicability in daily clinical routine with unselected populations. AIMS: The aims of the study were to prospectively analyze the predictive value of the TRS in a heterogeneous population admitted for chest pain and to construct where possible a new modified model with a greater prognostic capacity. POPULATION AND METHODS: Seven hundred eleven consecutive patients were admitted over a 1-year period to the cardiology unit for chest pain without ST-segment elevation. Thrombolysis in Myocardial Infarction risk score variables, relevant medical history variables, in-hospital examination results, and therapy information were collected. Cardiac events at 1 and 6 months were recorded. RESULTS: Seventy-one (9.8%) patients had a compound event (myocardial infarction/revascularization/cardiac death) at 6 months. On multivariate analysis, the variables associated with cardiac events were left ventricular ejection fraction (EF) of <35% (hazard ratio [HR] = 2.9, P = .002), diabetes (HR = 1.8, P = .02), and TRS (HR = 1.3, P = .007). Events at 6 months were 2.3% for a TRS of 0/1, 4.2% for 2, 10.2% for 3, 11.0% for 4, and 18.7% for a score of more than 5. A new modified scale was constructed to include EF and diabetes as independent variables, and this yielded an increase of 44% in the combined event at 6 months per score unit increase (HR = 1.44, P = .001). The modified scale showed a greater predictive capacity than the original model. CONCLUSIONS: The TRS is an important short- and long-term prognostic predictor when applied to an unselected population consulting for chest pain. The inclusion of diabetes and EF as variables in the model increases predictive capacity at no expense to simplicity.
Authors:
Francisco J García-Almagro; Juan R Gimeno; Manuel Villegas; Jose Hurtado; Francisca Teruel; Maria C Cerdán; Josefa González-Carrillo; Domingo Pascual; Miguel Rodríguez-Barranco; Mariano Valdés
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  26     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-15     Completed Date:  2008-04-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  439-45     Citation Subset:  IM    
Affiliation:
Cardiac Department, University Hospital Virgen de la Arrixaca, 30120 El Palmar, Murcia, Spain. jyf@ono.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / diagnosis*
Chest Pain / etiology*
Female
Health Status Indicators*
Humans
Male
Middle Aged
Models, Cardiovascular
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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