Abstract
BackgroundAccurate management of non-ST elevation myocardial infarction (NSTEMI) patients can be achieved by stratifying risks as early as possible on hospital admission. Previously, the Thrombolysis in Myocardial Infarction (TIMI) risk score has been validated and used on patients presenting with NSTEMI or unstable angina (UA) in developed countries. The aim of this study was to assess the validity of the TIMI risk score in patients presenting with NSTEMI in Pakistan.MethodsThis cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. The receiver operating characteristic (ROC) curve analysis was performed, and area under the curve (AUC) along with 95% confidence interval (CI) was reported. Univariate and multivariate logistic regression analysis was performed and odds ratio (OR) along with 95% CI was reported.ResultsThis cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. Validity of TIMI score in predicting hospital mortality 14 days after the diagnosis of NSTEMI in a population in Pakistan was assessed by ROC curve and logistic regression analysis. The AUC of the TIMI score for predicting 14-day outcome was 0.788 [95% CI: 0.689-0.887], with optimal cutoff of ≥4 with sensitivity of 77.78%. On multivariate analysis, cardiac arrest at presentation and the TIMI risk score were found to be independent predictors of 14-day mortality with adjusted ORs of 136.49 [10.23-1821.27] and 2.67 [1.09-6.57], respectively.ConclusionsThe TIMI risk score is a useful and simple score for the stratification of patients with high risk of 14-day mortality with reasonably acceptable discriminating ability in patients with NSTEMI acute coronary syndrome.
Highlights
Acute myocardial infarction (AMI) and unstable angina (UA) come under the broad umbrella of the term acute coronary syndrome (ACS), which accounts for nearly seven million deaths annually [1]
This cross-sectional study was undertaken on 300 patients who were diagnosed with non-ST elevation myocardial infarction (NSTEMI)
Data were collected from medical records, the Thrombolysis in Myocardial Infarction (TIMI) score was calculated, and 14-day outcome was recorded
Summary
Acute myocardial infarction (AMI) and unstable angina (UA) come under the broad umbrella of the term acute coronary syndrome (ACS), which accounts for nearly seven million deaths annually [1]. Despite improvement in therapeutic interventions in the recent decade, NSTEMI still accounts for high morbidity and mortality rates [5]. This makes it crucial to use adequate risk factor assessment to determine potentially fatal cardiac complications, which may enable physicians to provide suitable and timely therapeutic management to the most vulnerable patients, thereby reducing mortality rates [6,7,8]. The Thrombolysis in Myocardial Infarction (TIMI) risk score has been validated and used on patients presenting with NSTEMI or unstable angina (UA) in developed countries.
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