97 A Prospective Investigation of the Prognostic Value of “TIMI” and “Front Door TIMI” in Chinese Patients Presenting to the Emergency Department With Undifferentiated Chest Pain

Abstract

Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) and front door Thrombolysis in Myocardial Infarction risk score (FDTIMI-RS) have been proven to be useful to risk stratify chest pain patients in many Western countries, but it has not been validated in Asian countries. We hypothesised that the TIMI-RS would be a valid tool in the Hong Kong Chinese population. The aim of this study was to establish the relationship between TIMI-RS and FDTIMI-RS and the 30-day rate of major adverse cardiac outcomes (MACE) of patients with chest pain. Single center prospective observational cohort study. Consecutive ED patients presenting with chest pain were enrolled from July 2009 until March 2010. Data collection: patient characteristics, TIMI-RS items and past medical and medication history. Primary outcome: MACE within 30 days of ED presentation. MACE is defined as a composite outcome which is fulfilled if any of the following occurs: death (all causes), readmission with myocardial infarction (MI), acute coronary syndrome not diagnosed at initial ED presentation, and percutaneous coronary intervention. 1000 patients were recruited and 30-day follow-up was completed on all patients. Patients had a mean age of 66.7±14 years and 54% were male. 169 (17%) patients had a MACE within 30 days of ED presentation. The incidence of MACE in each TIMI-RS group is as follows: TIMI-RS 0, 1/145, (0.7%); TIMI-RS 1, 21/249 (8.4%); TIMI-RS 2, 44/239, (18.4%); TIMI-RS 3, 40/179, (22.3%); TIMI-RS 4, 42/122, (34.4%), TIMI-RS 5, 14/52, (26.9%), TIMI-RS 6/7, 7/14, (50%). There was an excellent correlation between TIMI-RS and MACE (ρ=0.964, p <0.001). Increasing FDTIMI-RS was also associated with increased risk of MACE within 30 days (ρ= 1, p=0.01). The TIMI-RS and FDTIMI-RS may be useful tools for risk stratification of ED patients with undifferentiated chest pain. However, patients in the low risk group still had a risk of having MACE (0.7% for TIMI-RS=0 and 1.3% for FDTIMI-RS=0). Therefore, while the scores can guide patient disposition from the ED, they cannot fully replace clinical judgement.