Navigating the Risk: “Unraveling the Relationship between Thrombolysis in Myocardial Infarction (“TIMI” Risk Score) and Coronary Vessel Involvement in Non-ST-Elevated acute Coronary Syndrome with Respect to “Syntax” Score – A Cross-sectional Study”

Abstract

Objectives: Patients with unstable angina and non-ST-elevated myocardial infarction (NSTEMI) present with a spectrum of cardiac events and death. Hence, early accurate management should be initiated. This can be achieved by risk stratifying the patients as early as possible on hospital admission. Thrombolysis in myocardial infarction (TIMI) risk score assessment is used widely for this purpose. It helps to standardize the approach of management and compare the extent and number of vessels involved in the coronary angiogram. This research aims to assess coronary artery disease (CAD) in individuals with NSTEMI by examining the extent of vessel involvement and the complexity of coronary artery blockages, using the SYNTAX score about the TIMI risk score. Materials and Methods: This cross-sectional observational study involved 60 participants who were selected based on specific inclusion and exclusion criteria. The TIMI risk score was computed for each individual, categorized as either <4 or ≥4, and the results of their coronary angiogram were analyzed to assess the degree of vessel involvement, categorizing it as either single-vessel disease (SVD) or multi-vessel disease (MVD). The Syntax score was computed for all angiograms and divided into two groups based on whether it was ≤22 or >22. Results: The average age of the participants in our study was 56 ± 10.64, with an age range of 34. Gender distribution revealed a higher proportion of males, constituting 68.3% (41 individuals), while females accounted for 31.7% (19 individuals). The angiogram results demonstrated that among the patients with TIMI score <4, 70% (14 individuals) had SVD, 30% (6 individuals) had MVD, and among those with score ≥4, 15% (6 individuals) had SVD while 75% (34 individuals) had MVD. In the subgroup analysis of TIMI <4, a Syntax score <22 was observed in 15 cases of SVD and a score >22 was observed in cases of MVD. Likewise, in the TIMI >4 group, a Syntax score <22 was observed in 12 cases of SVD and a score >22 was observed in 28 cases of MVD. Conclusion: This study noted that patients with non-ST-segment elevation acute coronary syndrome who underwent coronary angiogram and had a TIMI score of ≥4 were observed to have a 13-fold increased likelihood of having multi-vessel Coronary artery disease (CAD) compared to those with a TIMI score of <4. TIMI score of ≥4 had a 7 times higher chance of getting a SYNTAX score >22.