Abstract
Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain.Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed.Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: <27 (n = 348), 27–36 (n = 360) and >36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p < 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p < 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p < 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p < 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p < 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p < 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p < 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI > 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI > 42.0 had higher 1 year mortality (Log-rank = 79.2, p < 0.001).Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.
Highlights
ST-segment elevation myocardial infarction (STEMI), defined as ST-segment elevation in at least two contiguous leads, has been introduced as a subtype of acute coronary syndrome for purposes of immediate treatment
TIMI Risk Index (TRI) showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p < 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for acute kidney injury (AKI) (AUC = 0.678, p < 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital major adverse clinical events (MACEs) (AUC = 0.669, p < 0.001; Hosmer-Lemeshow p = 0.077)
TRI is suitable for risk stratification in elderly patients with STEMI undergoing Percutaneous coronary intervention (PCI), and is of continuing value for an aging population
Summary
ST-segment elevation myocardial infarction (STEMI), defined as ST-segment elevation in at least two contiguous leads, has been introduced as a subtype of acute coronary syndrome for purposes of immediate treatment. Percutaneous coronary intervention (PCI) is a class IB treatment in STEMI patients, given that early invasive revascularization therapy can greatly decrease mortality [1]. As the elderly population has grown, patients older than 75 years have come to constitute more than 60% of STEMI cases [2]. The mean age of candidates for PCI increased by 7 years from 1990 to 2010, and patients aged 75 and over make up 28% of those who undergo PCI in Sweden [3]. Age is an independent risk factor for long-term mortality in STEMI, with every oneyear increase in age equating to a 1.07 times increase in risk of death [4]. Its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain
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