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Current outcomes and outcome measures in acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Dinkar Bhasin, Shaheer Ahmed, Nitish Naik
Several risk assessment scores that allow triage of patients presenting with NSTE-ACS have been developed. The most widely used and validated scores are the TIMI risk score and GRACE (Global Registry of Acute Coronary Events) risk score. The TIMI risk score is a simple additive score consisting of seven points that can be easily calculated by hand (Table 3.5) [52]. The GRACE score consists of weighted risk factors and requires detailed calculation [53]. Long-term risk assessment after NSTE-ACS can be done using the TIMI stable ischaemic CAD risk score. It is based on nine risk factors and predicts the risk of cardiovascular events allowing intensification of medical therapy [54].
Patient risk assessment: Use of risk calculators
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
The grandfather of chest pain scoring systems could be said to be the TIMI (Thrombolysis in myocardial infarction) risk score.16 It was created in the 1990s from the Thrombolysis in Myocardial Infarction 11B trial and Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and Non-Q-Wave Coronary Event Trial.17 The TIMI risk score provides a simple estimate of the 30-day mortality in patients with a confirmed diagnosis of acute coronary syndrome (ACS) and has been used to base more aggressive therapy. It must be noted that this is not a score to stratify indeterminate chest pain as to likelihood of ischemia.
Cardiovascular medicine
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
The Global Registry of Acute Coronary Events (GRACE) study has been used to derive regression models to predict death in hospital and death after discharge in patients with acute coronary syndrome. The Thrombolysis in Myocardial Infarction (TIMI) score, similarly, was developed to provide a simple risk score that has broad applicability, is easily calculated at patient presentation, does not require a computer, and identifies patients with different responses to treatments for unstable angina or NSTEMI.
A comparison of risk scores’ long-term predictive abilities for patients diagnosed with ST elevation myocardial infarction who underwent early percutaneous coronary intervention
Published in Scandinavian Cardiovascular Journal, 2022
Ali Aldujeli, Ayman Haq, Anas Hamadeh, Auguste Stalmokaite, Laurynas Maciulevicius, Egle Labanauskaite, Inesa Navickaite, Zemyna Kurnickaite, Gediminas Jarusevicius, Ramunas Unikas, Diana Zaliaduonyte, Kristen M. Tecson
For all patients, demographics, clinical presentation, and other determinants of the TIMI score for STEMI (i.e. age, heart rate, systolic blood pressure, weight, Killip class, history of diabetes or hypertension, ECG parameters and the time required for reperfusion) were documented on admission and assessed by two experienced cardiologists. TIMI score was calculated using the TIMI scoring algorithm on the TIMI score website (https://timi.org/) [18]. Similarly, GRACE risk score 2.0 was calculated by two experienced cardiologists after evaluating the factors at admission (i.e. age, heart rate, systolic blood pressure, serum creatinine concentration, the presence of ST-segment deviation, cardiac arrest during admission, elevated serum cardiac biomarkers, and Killip class) using the GRACE 2.0 ACS risk calculator available online (https://www.outcomes-umassmed.org/grace/acs_risk2/) [19].
The prognostic role of intra-aortic pulse pressure measured before percutaneous coronary intervention in patients with chronic coronary syndrome: a single-center, retrospective, observational cohort study
Published in Clinical and Experimental Hypertension, 2022
Clinical and hemodynamic information was gathered from the cardiac catheterization laboratory register and electronic medical records. PCI was performed in all vessels in the following circumstances: (i) the presence of high-grade stenosis (>90%) (ii) 50%–90% stenosis with high ischemic burden at nuclear imaging (ie. >10% of the myocardium), (iii) 50%–90% stenosis with hemodynamically relevant lesion defined by FFR ≤ 0.80. All patients underwent PCI via the radial or femoral approach. Before the intervention, all patients had been treated with acetylsalicylic acid, clopidogrel, and unfractionated heparin at a dose of 70–100 U/kg. The procedure successful criteria were set as follows: (i) the achievement of thrombolysis in myocardial infarction (TIMI) III, (ii) no residual lesion after PCI, (iii) absence of stent thrombosis in the first 24 hours. Procedural details such as, type of drug-eluting stent (DES) or bare-metal stent (BMS), length and diameter of the stent, and the synergy between PCI with taxus and cardiac surgery (SYNTAX) score were also recorded. In case of more than one stent requirement, stent length was considered the total length of all implanted stents, and stent diameter was considered the diameter of the narrowest stent. Further, for patients who had more than one catheterization during the following period, the only information available at the first procedure was considered.
Is the thrombolysis in myocardial infarction (TIMI) score a reliable source in a rural hospital for the management of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI)?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Khalid Sawalha, Shoaib Khan, Edwin Suarez, Nicholas Beresic, Gilbert-Roy Kamoga
There are quite a few potential explanations that can account for the findings of this study. Prior investigation has shown that rural neighborhoods tend to have increased rates of chronic disease, higher numbers of uninsured citizens, fewer physicians, and nurses per capita and people are less likely to seek out assistance from healthcare providers until later in the disease course [4]. In rural America, healthcare resources are limited, and patients are very easily lost to follow up. Hence, due to the lack of regular primary care follow up, patients are more likely to develop risk factors such as continued smoking, hypertension, and diabetes that can cause elevated TIMI scores in rural settings. Moreover, given the advances in medicine, the average lifespan in rural America has risen to 76.7 years [5]. With an increasing baby boomer population, patients are more likely to automatically earn an extra one point for being over the age of 65 on their risk stratification with TIMI scoring when presenting with UA/NSTEMI. Of the seven components of TIMI scoring system, three factors specifically (positive cardiac markers, EKG ST changes, and known CAD stenosis) are objective accurate predictors of known active or prior Acute Coronary Syndrome (ACS). Given the discrepancies in rural healthcare settings, risk stratification models in UA/NSTEMI should weigh objective coronary risk factors more heavily in order to judiciously use limited healthcare resources and limit patients from unnecessary interventional risk.