(Circulation. 2000;102:2031.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation
An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy
From the Department of Medicine (D.A.M., E.M.A., J.A.d.L., R.P.G., C.H.M., E.B.), Brigham and Women’s Hospital, Boston, Mass; Nottingham Clinical Research (A.C., R.C.), Nottingham, UK; and the Department of Medicine (S.A.M.), University of California, San Francisco.
Correspondence to David A. Morrow, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail damorrow{at}bics.bwh.harvard.edu
Background—Considerable variability in mortality risk exists among patients with ST-elevation myocardial infarction (STEMI). Complex multivariable models identify independent predictors and quantify their relative contribution to mortality risk but are too cumbersome to be readily applied in clinical practice.
Methods and Results—We developed and evaluated a convenient bedside clinical risk score for predicting 30-day mortality at presentation of fibrinolytic-eligible patients with STEMI. The Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI was created as the simple arithmetic sum of independent predictors of mortality weighted according to the adjusted odds ratios from logistic regression analysis in the Intravenous nPA for Treatment of Infarcting Myocardium Early II trial (n=14 114). Mean 30-day mortality was 6.7%. Ten baseline variables, accounting for 97% of the predictive capacity of the multivariate model, constituted the TIMI risk score. The risk score showed a >40-fold graded increase in mortality, with scores ranging from 0 to >8 (P<0.0001); mortality was <1% among patients with a score of 0. The prognostic discriminatory capacity of the TIMI risk score was comparable to the full multivariable model (c statistic 0.779 versus 0.784). The prognostic performance of the risk score was stable over multiple time points (1 to 365 days). External validation in the TIMI 9 trial showed similar prognostic capacity (c statistic 0.746).
Conclusions—The TIMI risk score for STEMI captures the majority of prognostic information offered by a full logistic regression model but is more readily used at the bedside. This risk assessment tool is likely to be clinically useful in the triage and management of fibrinolytic-eligible patients with STEMI.
Key Words: coronary disease • prognosis • myocardial infarction • mortality • risk factors
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F. Schiele, N. Meneveau, M. F. Seronde, F. Caulfield, R. Fouche, G. Lassabe, D. Baborier, P. Legalery, J.-P. Bassand, and on behalf of the Reseau de Cardiologie de Franche Compliance with guidelines and 1-year mortality in patients with acute myocardial infarction: a prospective study Eur. Heart J., May 1, 2005; 26(9): 873 - 880. [Abstract] [Full Text] [PDF]
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M. Suleiman, H. Hammerman, M. Boulos, M. R. Kapeliovich, A. Suleiman, Y. Agmon, W. Markiewicz, and D. Aronson Fasting Glucose Is an Important Independent Risk Factor for 30-Day Mortality in Patients With Acute Myocardial Infarction: A Prospective Study Circulation, February 15, 2005; 111(6): 754 - 760. [Abstract] [Full Text] [PDF]
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G. C. Fonarow, K. F. Adams Jr, W. T. Abraham, C. W. Yancy, W. J. Boscardin, and for the ADHERE Scientific Advisory Committee, Stud Risk Stratification for In-Hospital Mortality in Acutely Decompensated Heart Failure: Classification and Regression Tree Analysis JAMA, February 2, 2005; 293(5): 572 - 580. [Abstract] [Full Text] [PDF]
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A. Kashani, R. P. Giugliano, E. M. Antman, D. A. Morrow, C. M. Gibson, S. A. Murphy, and E. Braunwald Severity of heart failure, treatments, and outcomes after fibrinolysis in patients with ST-elevation myocardial infarction Eur. Heart J., October 1, 2004; 25(19): 1702 - 1710. [Abstract] [Full Text] [PDF]
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S. D. Wiviott, D. A. Morrow, P. D. Frederick, R. P. Giugliano, C.M. Gibson, C. H. McCabe, C. P. Cannon, E. M. Antman, and E. Braunwald Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and -4: A simple index that predicts mortality in ST-segment elevation myocardial infarction J. Am. Coll. Cardiol., August 18, 2004; 44(4): 783 - 789. [Abstract] [Full Text] [PDF]
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T. J. Ryan The thrombolysis in myocardial infarction risk index: A formula with a future J. Am. Coll. Cardiol., August 18, 2004; 44(4): 790 - 792. [Full Text] [PDF]
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Writing Committee Members, E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, et al. ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J. Am. Coll. Cardiol., August 4, 2004; 44(3): 671 - 719. [Full Text] [PDF]
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E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Circulation, August 3, 2004; 110(5): 588 - 636. [Full Text] [PDF]
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R. Fincke, J. S. Hochman, A. M. Lowe, V. Menon, J. N. Slater, J. G. Webb, T. H. LeJemtel, G. Cotter, and SHOCK Investigators Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK trial registry J. Am. Coll. Cardiol., July 21, 2004; 44(2): 340 - 348. [Abstract] [Full Text] [PDF]
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D. A. Morrow, E. M. Antman, S. A. Murphy, S. F. Assmann, R. P. Giugliano, C. P. Cannon, C. Michael Gibson, C. H. McCabe, H. V. Barron, F. Van de Werf, et al. The Risk Score Profile: a novel approach to characterising the risk of populations enrolled in clinical studies Eur. Heart J., July 1, 2004; 25(13): 1139 - 1145. [Abstract] [Full Text] [PDF]
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K. A. Eagle, M. J. Lim, O. H. Dabbous, K. S. Pieper, R. J. Goldberg, F. Van de Werf, S. G. Goodman, C. B. Granger, P. G. Steg, J. M. Gore, et al. A Validated Prediction Model for All Forms of Acute Coronary Syndrome: Estimating the Risk of 6-Month Postdischarge Death in an International Registry JAMA, June 9, 2004; 291(22): 2727 - 2733. [Abstract] [Full Text] [PDF]
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