Validation of the TIMI risk score in Chinese patients presenting to the emergency department with chest pain

Abstract

The Thrombolysis In Myocardial Infarction (TIMI) risk score is a 7 item tool which has been validated in Western medical literature to help risk stratify chest pain patients. The aim of this study is to establish the relationship between the TIMI risk score and the rate of occurrence of Major Adverse Cardiovascular Events (MACE) within 30 days in Chinese patients presenting to the emergency department (ED) with undifferentiated chest pain. Methods Design - single center prospective observational study of adult Chinese ED patients with undifferentiated chest pain. Setting - University hospital emergency department in Hong Kong with annual census of 140000 patients. Subjects - all adult patients presenting with undifferentiated chest pain. Data, including patient characteristics, medical history and components of the TIMI risk score was collected. All patients were followed up at 30 days, either by review of electronic medical records or telephone interview. MACE was defined as death from any cause; myocardial infarction; troponin elevated acute coronary syndrome or undergoing percutaneous coronary intervention. Rates of MACE at 30 days were examined in relation to TIMI risk score. Results Follow-up at 30 days was completed for a total of 315 patients. There were a further 37 patients who did not give consent to be included in the study. Median age was 69 years and 55% of the participants were male. A MACE occurred in 57 patients (18%). Rates of MACE according to TIMI risk score were: TIMI 0, 3/37 (8%); TIMI 1, 4/79 (5%); TIMI 2, 12/77 (16%); TIMI 3, 15/67 (22%); TIMI 4 13/36 (36%); TIMI 5, 5/14 (36%); TIMI 6, 5/5 (100%); TIMI 7 0/0 (p<0.005). Conclusion Increasing TIMI risk score is strongly associated with risk of MACE in chest pain patients. The TIMI risk score is sensitive enough to identify Chinese patients at high risk of an adverse event but not specific enough to identify patients suitable for early discharge.