Screening Characteristics of TIMI Score in Predicting Acute Coronary Syndrome Outcome; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 5 No. 1 (2017),
1 January 2017
,
Page e18
https://doi.org/10.22037/aaem.v5i1.142
Abstract
Introduction:Â In cases with potential diagnosis of ischemic chest pain, screening high risk patients for adverse outcomes would be very helpful. The present study was designed aiming to determine the diagnostic accuracy of thrombolysis in myocardial infarction (TIMI) score in Patients with potential diagnosis of ischemic chest pain.
Method:Â This diagnostic accuracy study was designed to evaluate the screening performance characteristics of TIMI score in predicting 30-day outcomes of mortality, myocardial infarction (MI), and need for revascularization in patients presenting to ED with complaint of typical chest pain and diagnosis of unstable angina or Non-ST elevation MI.
Results: 901 patients with the mean age of 58.17 ± 15.00 years (19-90) were studied (52.9% male). Mean TIMI score of the studied patients was 0.97 ± 0.93 (0-5) and the highest frequency of the score belonged to 0 to 2 with 37.2%, 35.3%, and 21.4%, respectively. In total, 170 (18.8%) patients experienced the outcomes evaluated in this study. Total sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of TIMI score were 20 (95% CI: 17 – 24), 99 (95% CI: 97 – 100), 98 (95% CI: 93 – 100), 42 (95% CI: 39 – 46), 58 (95% CI: 14 – 229), and 1.3 (95% CI: 1.2 – 1.4), respectively. Area under the ROC curve of this system for prediction of 30-day mortality, MI, and need for revascularization were 0.51 (95% CI: 0.47 – 0.55), 0.58 (95% CI: 0.54 – 0.62) and 0.56 (95% CI: 0.52 – 0.60), respectively.
Conclusion:Â Based on the findings of the present study, it seems that TIMI score has a high specificity in predicting 30-day adverse outcomes of mortality, MI, and need for revascularization following acute coronary syndrome. However, since its sensitivity, negative predictive value, and negative likelihood ratio are low, it cannot be used as a proper screening tool for ruling out low risk patients in ED.
- Coronary artery disease
- prognosis
- myocardial infarction
- decision support techniques
- angina
- unstable
How to Cite
References
Hata J, Kiyohara Y. Epidemiology of stroke and coronary artery disease in Asia. Circulation Journal. 2013;77(8):1923-32.
Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113(6):e85.
Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in US deaths from coronary disease, 1980–2000. New England Journal of Medicine. 2007;356(23):2388-98.
Beaglehole R. International trends in coronary heart disease mortality and incidence rates. European Journal of Cardiovascular Risk. 1999;6(2):63-8.
Huffman MD, Lloyd-Jones DM, Ning H, et al. Quantifying Options for Reducing Coronary Heart Disease Mortality By 2020Clinical Perspective. Circulation. 2013;127(25):2477-84.
Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease. European heart journal. 2013;34(38):2949-3003.
Roffi M, Patrono C, Collet J-P, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European heart journal. 2015:ehv320.
Ehsan MA, Mahmood M, Siddique MA, et al. Prediction of Major Adverse Cardiac Events of Patients with Acute Coronary Syndrome by Using TIMI Risk Score. University Heart Journal. 2013;8(2):73-9.
Damman P, Woudstra P, Kuijt WJ, et al. Shortâ€and Longâ€Term Prognostic Value of the TIMI Risk Score after Primary Percutaneous Coronary Intervention for STâ€segment Elevation Myocardial Infarction. Journal of interventional cardiology. 2013;26(1):8-13.
Lee B, Chang AM, Matsuura AC, Marcoon S, Hollander JE. Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome. Critical pathways in cardiology. 2011;10(2):64-8.
Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non–ST elevation MI: a method for prognostication and therapeutic decision making. Jama. 2000;284(7):835-42.
Marcoon S, Chang AM, Lee B, Salhi R, Hollander JE. HEART score to further risk stratify patients with low TIMI scores. Critical pathways in cardiology. 2013;12(1):1-5.
Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE. Application of the TIMI risk score for unstable angina and nonâ€ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Academic emergency medicine. 2006;13(1):13-8.
Hess EP, Agarwal D, Chandra S, et al. Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis. Canadian Medical Association Journal. 2010;182(10):1039-44.
- Abstract Viewed: 415 times
- PDF Downloaded: 201 times
- HTML Downloaded: 40 times
Download Statastics
Make a Submission
SJR
COPE
