Hippokratia 2005; 9(2): 80- 86
I Vogiatzis, T Karamitsos, E Kambitsi, M Kachrimanidou, D Samanidis, P Prodromidis
Cardilogy Dpt, General Hospital of Veria, Veria, Greece
Background: Patients with Unstable Angina / Non ST segment elevation myocardial infarction (UA / NSTEMI) present a wide spectrum of risk for death and new cardiac ischemic events. It is useful to develop a simple risk score, easily calculated at patient presentation, with broad applicability, to identify patients at risk and with different responses to treatments for UA / NSTEMI. The aim of the study is to examine the clinical application of TIMI Risk Score and its prognostic significance to risk stratification of patients with acute coronary syndromes (UA / NSTEMI).
Methods. 380 patients (295 patients with UA and 85 patients with NSTEMI) were studied (mean age 65.7+18.73 years). Timi Risk Score was achieved for each patient using the summation of seven variables (value of 1 when the variable was present at patient admission) : age > 65 years, at least 3 factors for coronary artery disease, prior history of coronary artery disease, at least 2 anginal events in prior 24 hours, ST segment deviation on electrocardiogram at presentation, elevated cardiac markers and use of aspirin in prior 7 days. End points were all cause mortality and complications (new or recurrent MI, ischemia, urgent revascularization) through 30 days and the relationship with TIMI Risk score.
Results. Event rates increased significantly as the TIMI Risk Score increased : 0.64 % for Score 0 / 1, 8.4 % for Score 2, 8.48 for Score 3, 10.9 % for Score 4, 21.2 % for Score 5, 23.64 % for Score 6 and 32.72% for TIMI risk score 7 (p=0.04 by x2). There was a significant interaction between TIMI Risk Score with female gender (p=0.05) and no interaction with biochemical factors as lipids, fibrinogen, CRP.
Conclusion. In patients with UA / NSTEMI the TIMI Risk Score is a simple prognostic scheme that categorizes a patients' risk of death and cardiac events and provides a basis for therapeutic decision making.
Keywords: coronary artery disease, acute coronary syndromes, unstable angine, non ST elevation myocardial infarction, risk stratification, TIMI risk score