Document Detail

The thrombolysis in myocardial infarction risk score in unstable angina/non-ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  12644346     Owner:  NLM     Status:  MEDLINE    
Risk stratification in unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) can provide an estimate of a patient's prognosis and optimize clinical choices. The Thrombolysis In Myocardial Infarction (TIMI) risk score for UA/NSTEMI is an integrated approach that uses baseline variables that are part of the routine medical evaluation to identify patients at high risk for death and other major cardiac ischemic events. Using multivariable logistic regression, seven independent predictor variables were identified: age > or = 65 years, > or = 3 risk factors for coronary artery disease (CAD), known CAD (stenosis > or = 50%), severe anginal symptoms (> or = 2 anginal events in preceding 24 h), use of aspirin in the last seven days, ST-segment deviation > or = 0.05 mV, and elevated serum cardiac markers of necrosis. Each predictor carried similar prognostic weight; therefore, a risk score was constructed as the simple arithmetic sum of the number of predictors. The rate of death, MI, or urgent revascularization significantly increased as the TIMI risk score increased, ranging from < 5% for patients with a risk score of 0 or 1 to > 40% for patients with a risk score of 6 or 7. The risk score has been validated in several other trials of UA/NSTEMI. In addition, using the risk score to categorize patients also effectively defines a gradient for benefit with specific treatments such as low-molecular-weight heparins, glycoprotein IIb/IIIa inhibitors, and an early invasive strategy.
Marc S Sabatine; Elliott M Antman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  41     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-03-19     Completed Date:  2003-06-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  89S-95S     Citation Subset:  AIM; IM    
TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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MeSH Terms
Acute Disease
Angina, Unstable / diagnosis*,  drug therapy,  mortality
Anticoagulants / therapeutic use*
Drug Therapy, Combination
Heparin / therapeutic use*
Logistic Models
Myocardial Infarction / diagnosis*,  drug therapy,  mortality
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Risk Assessment
Thrombolytic Therapy*
Troponin / blood
Tyrosine / analogs & derivatives,  therapeutic use*
Grant Support
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Troponin; 144494-65-5/tirofiban; 55520-40-6/Tyrosine; 9005-49-6/Heparin

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