Document Detail

Thrombolysis in Myocardial Infarction (TIMI) Risk Index predicts long-term mortality and heart failure in patients with ST-elevation myocardial infarction in the TIMI 2 clinical trial.
MedLine Citation:
PMID:  19332194     Owner:  NLM     Status:  MEDLINE    
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 long-term 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 < .0001) and was also increased in group 4 (HR 2.80, P < .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 < .0001) and the highest risk for composite death/CHF (HR 4.35, P < .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 < .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.
Quynh A Truong; Christopher P Cannon; Neil A Zakai; Ian S Rogers; Robert P Giugliano; Stephen D Wiviott; Carolyn H McCabe; David A Morrow; Eugene Braunwald
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2009-02-23
Journal Detail:
Title:  American heart journal     Volume:  157     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-21     Revised Date:  2011-12-07    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  673-9.e1     Citation Subset:  AIM; IM    
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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MeSH Terms
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Heart Failure / epidemiology*,  etiology
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  mortality
Risk Factors
Survival Rate / trends
Thrombolytic Therapy / methods*
Time Factors
United States / epidemiology
Grant Support
K23 HL098370-03/HL/NHLBI NIH HHS; L30 HL093806-01/HL/NHLBI NIH HHS; L30HL093896/HL/NHLBI NIH HHS; T32 HL076136-05/HL/NHLBI NIH HHS; T32HL076136/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Fibrinolytic Agents

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

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