TIMI Risk Index Research Articles

Comparison between GRACE and TIMI Risk Scores in Predicting the Severity and Extent of Coronary Artery Disease in Patients with NSTEACS

Background: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the thrombolysis in myocardial infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients Non ST segment elvation acute coronary syndrome (NSTE-ACS). Aim: The aim of this study is to compare the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with (NSTE-ACS) using Syntax score Methods: A total number of 100 patients were admitted to National Heart Institute CCU with NSTE-ACS undergoing coronary angiography. Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS 140) risk groups according to GRS score and into group 1 (TRI 0-2), group 2 (TRI 3-4), and group 3 (TRI 5-7) according to TRI score. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. Results: There were significant correlation between both GRACE and TRI score and SS (r=0.551, p<0.001) (r=0.309, p=0.046) respectively, there were no significant difference between area under the curve in predicting extent of CAD p= 0.185 although GRACE score showed higher significance in correlation with SS Conclusion: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS

The value of pre admission Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) in the prediction of no-reflow phenomenon after primary percutaneous coronary intervention in patients presented with ST Segment Elevation Myocardial Infarction (STEMI)

Background: Coronary artery disease and acute coronary syndrome (ACS) are the major causes of death, worldwide. Risk assessment for patients with ACS is necessary to minimize morbidity and mortality. The global registry of acute coronary events risk score (GRS), the in thrombolysis myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been used for patients with ACS to evaluate their risk. We showed at our study the value of pre-admission TRI, TRS, and GRS in occurrence prediction of no-reflow (NRF) Phenomenon after primary PCI for ST-elevation myocardial infarction (STEMI) patients; and its impact on the in-hospital outcome for those patients. Patients and Methods: Our study included 319 patients presented with STEMI and managed by primary PCI. For all patients, we recorded a detailed history, clinical examination as well as Killip class, electrocardiogram, and echocardiography. TRI as well, TRS, and GRS were calculated for all patients. We observed all patients during their PCI at the catheterization room to monitor the result of the intervention. NRF was defined as TIMI flow grade less than III or TIMI flow Grade III with myocardial blush grade less than or equal to II. Then, we followed the patients during their hospitalization period to record any associated complications and mortality. Results: We found NRF patients older than reflow patients, thus regarding age. They were more males. Killip Class III-IV was found to be more common in NRF patients. TRI as well, TRS and GRS showed higher values among the NRF patients. As well, in-hospital major adverse cardiac events (MACEs) and mortality were more common in NRF patients. Conclusion: We found that the high TRI values were related to the occurrence of NRF, in hospital MACE, and mortality.

A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index

BackgroundThrombolysis in Myocardial Infarction (TIMI) risk index (TRI) was recently evaluated in patients with acute myocardial infarction and found as an important prognostic index. In the current study, we evaluated the prognostic value of TRI in patients with moderate-high and high risk pulmonary embolism (PE) who were treated with thrombolytic agents. MethodsWe retrospectively evaluated the in-hospital and long-term (4-year) prognostic impact of TRI in a total number of 456 patients with moderate-high and high risk PE. Patients were stratified by quartiles (Q) of admission TRI. ResultsIn-hospital analysis revealed significantly higher rates of in-hospital death for patients with TRI in Q4. After adjustment for confounding baseline variables, TRI in Q4 was associated with 2.8-fold hazard of in-hospital death. Upon multivariate analysis, admission TRI in Q4 vs. Q1–3 was associated with 3.1 fold hazard of 4-year mortality rate. ConclusionTRI in Q4, as compared to Q1–3, was significantly predictive of short term and long-term outcomes in PE patients who treated with thrombolytic agents. Our data suggest TRI to be an independent, feasible, and cost-effective tool for rapid risk stratification in moderate-high and high risk PE patients who treated with thrombolytic agents.

TIMI Risk Index as a Predictor of 30-Day Outcomes in Patients With Acute Pulmonary Embolism

Available studies have already identified age, heart rate (HR) and systolic blood pressure (SBP) as strong predictors of early mortality in acute pulmonary embolism (PE). One-hundred-seventy patients, with acute PE confirmed on computed tomography angiography (CTA) were enrolled. Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) was calculated using the formula [heart rate (HR) x (AGE/102)/ systolic blood pressure (SBP)]. Study outcomes were 30-day mortality and/or clinical deterioration. Receiver operating characteristics (ROC) curve revealed that a TRI ≥45 was highly specific for both outcomes (AUC 0.91, 95% CI 0.83-0.98, p<0.0001) with a positive predictive value (PPV) and negative predictive value (NPV) of 8.3 and 96% for 30-day mortality while PPV and NPV for 30-day mortality and/or clinical deterioration were 21.1 and 98.2%, respectively. Multivariate regression analysis showed that TRI ≥45 was an independent predictor of 30-day mortality (O.R. 22.24, 95% CI 2.54-194.10, p=0.005) independently from positive cTnI and RVD (O.R. 9.57, 95% CI 1.88-48.78, p=0.007; OR 24.99, 95% CI 2.84-219.48, p=0.004). Similarly, 30-day mortality and/or clinical deterioration was predicted by TRI ≥45 (O.R. 11.57, 95% CI 2.36-56.63, p=0.003) and thrombolysis (3.83, 95% CI 1.04-14.09, p=0.043), independently from age, RVD and positive cTnI. Cox regression analysis confirmed the role of TRI as independent predictor for both outcomes. Mantel-Cox analysis showed that after 30-day follow-up there was a statistically significant difference in the distribution of survival between patients with and without TRI ≥45 [log rank (Mantel-Cox) chi-square 17.04, p<0.0001]. Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) predicted both 30-days mortality (all-causes) and/or clinical deterioration in patients with acute PE.

Usefulness of the thrombolysis in myocardial infarction risk index in acute heart failure: a pilot study

BackgroundRisk stratification in acute heart failure (AHF) is vital for both physicians and paramedical personals. Thrombolysis in myocardial infarction (TIMI) risk index (TRI) and modified TRI (mTRI) are novel and simple predictive risk indices that have been examined in patients with acute coronary syndrome. ObjectiveIn the current study, we evaluated the relationship among TRI, mTRI, and mortality in patients with AHF. MethodsA total of 293 patients with AHF were retrospectively analyzed. The patients were divided into 2 groups: group 1 consisted of patients who survived and group 2 consisted of patients who died during a follow-up period of 120 days. Multivariate hierarchical logistic regression analysis was performed to evaluate the relationship among TRI, mTRI, and mortality. ResultsAll causes of death occurred in 84 patients (28.6%). Thrombolysis in myocardial infarction risk index was significantly higher in patients who died during follow-up (20.2 ± 12.4 vs 14.8 ± 8.9). The new risk score showed good predictive value for 120-day mortality. Before laboratory analysis, in-multivariate hierarchical logistic regression analysis TRI remained as an independent risk factor for mortality (odds ratio, 2.56; P < .001). After the laboratory analysis, despite the fact that TRI has lost its predictive value, mTRI remained an independent risk factor for mortality (odds ratio, 2.08; P = .01). ConclusionThe TRI is a simple and strong predictor of all-cause mortality in patients who were admitted with AHF. The current study reveals for the first time the strong predictive value of TRI in patients with AHF.

The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI.

The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI). ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of <2 in a manner as described in previous studies. A total of 371 patients (aged 62 ± 14 years; 73/27 men to women ratio) who underwent p-PCI were enrolled in the study. In terms of age, NRF patients were older than reflow patients (P < 0.017 for MBG). Killip class III-IV designations were more common in NRF patients (P = 0.029 for MBG). TRI (P = 0.014 for MBG) values were significantly greater in the NRF group. TRI was an independent predictor of NRF according to MBG flow (P = 0.003, B = -0.035, Exp B = 0966, 95% CI, 0.944-0.988). Admission TRI may predict the development of NRF phenomenon after p-PCI in patients with acute STEMI.

The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention.

The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) have been reported in patients with coronary artery disease (CAD). In this study, we sought to evaluate the association between TRI and the extent and severity of CAD evaluated by SYNTAX score (SS) and Gensini score in patients with ST elevation myocardial infarction (STEMI). A total of 290 patients with STEMI were included in the study. GRS and TRI were calculated on admission using specified variables. The extent and severity of CAD were evaluated using the SS and Gensini scores. The patients were divided into low (TRI ⩽19), intermediate (TRI 19-30), and high (TRI ⩾30) risk groups. A Pearson correlation analysis was used for the relationship between TRI, GRS, Gensini score and SS. There were significant differences in the mean age (p < 0.001), admission heart rate (p < 0.001), admission systolic blood pressure (p = 0.009), SS (p < 0.001), GRS (p < 0.001) and in-hospital major adverse cardiac events (MACE) in all patients between the low, intermediate and high TRI risk groups. There was a positive significant correlation between TRI and SS (r = 0.24, p < 0.001), Gensini score (r = 0.18, p = 0.002), GRS (r = 0.74, p = 0.001) and in-hospital MACE (r = 0.29, p < 0.001). TRI is significantly related to SS and Gensini score in predicting the extent and severity of CAD in patients with STEMI.

PT162 Prediction of Major Adverse Cardiac Events of Patients With Acute Coronary Syndrome In Hospital Using Timi Risk Score And Timi Risk Index

PT162 Prediction of Major Adverse Cardiac Events of Patients With Acute Coronary Syndrome In Hospital Using Timi Risk Score And Timi Risk Index

Degree of Beta-Blockade and Outcomes in Patients with Acute Coronary Syndrome

Objective: We sought to determine if the outcome benefit of beta blockade in the ACS population is associated with baseline HR, discharge HR, or a reduction in HR. Background: ACC guidelines recommend a resting HR goal of 50 to 60 bpm in ACS patients. This recommendation is not based on study outcomes, but rather on expert opinion. Evidence-based clinical trials investigating ideal target heart rate of beta blocker (BB) therapy in the ACS population are lacking. Methods: A retrospective analysis was performed of all ACS patients who underwent coronary angiography (with or without percutaneous coronary intervention) at Providence Hospital from September 2006 to August 2011 excluding patients with any contraindication to BB therapy. Discharge HR was used as the predictor variable for outcomes in these patients. Results: A total of 912 patients (403 ST elevation myocardial infarction MI (STEMI) and 509 Non STEMI patients were included. Discharge HR was divided into quintiles: quintile 1 (48 - 64 bpm), quintile 2 (65 - 70), quintile 3 (71 - 76), quintile 4 (77 - 83) and quintile 5 (84 - 119). There was a statistically significant difference seen between the quintile 1 composite endpoint and the other quintile endpoints. (p value <0.05) No differences were seen across quintiles in median TIMI risk index score at admission, systolic and diastolic blood pressure or beta-blocker dose at discharge. Patients in quintile 1 fared better overall with the observation of worse outcomes in patients with a discharge heart rate less than 55. Conclusion: In those with ACS, particularly STEMI and NSTEMI, a lower discharge HR conferred a decreased composite endpoint at 24 months with the best outcomes seen at a resting HR between 55-65. Further studies are needed to investigate the clinical benefit of optimal HR reduction in this population beyond 2 years.

Prediction of major adverse cardiac events of patients with acute coronary syndrome by using TIMI risk index

Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for unstable angina/non ST elevation myocardial infarction &amp; ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TRI. This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History &amp; physical examinations were done. TIMI risk index were calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting &amp; outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Major adverse events of TIMI risk index group 1, 2, 3, 4 &amp; 5 were 0%, 0%, 3.7%, 12.9% &amp; 19.2% respectively in UA/NSTEMI group. In STEMI group major adverse cardiac events of TIMI risk index group 1, 2, 3, 4 &amp; 5 were 0%, 4.7%, 12.5%, 17.1% &amp; 24.1% respectively. Increasing TRI were associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16024 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 52-57

Elevated serum osteoprotegerin levels predict in-hospital major adverse cardiac events in patients with ST elevation myocardial infarction

The aim of our study was to investigate whether osteoprotegerin (OPG) is related to in-hospital major adverse cardiac events (MACE) and reperfusion parameters in patients with ST elevation myocardial infarction (STEMI). The OPG/receptor activator of nuclear factor-κB (RANK)/RANK ligand pathway has recently been associated with atherosclerosis. OPG is a predictor of cardiovascular events in patients with acute coronary syndrome. This study included 96 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Two groups with equal number of patients were formed according to median OPG level. The association of OPG levels on admission with post-procedural reperfusion parameters, and in-hospital MACE were investigated. Patients with higher OPG levels displayed higher neutrophil/lymphocyte ratio, admission troponin, admission glucose, and high-sensitive C-reactive protein. Higher OPG levels were associated with increased thrombolysis in myocardial infarction (TIMI) risk score, TIMI risk index, pain to balloon time, need for inotropic support, shock, and MACE, mainly driven by death. Reperfusion parameters were not different between the two groups. TIMI risk score, TIMI risk index, myocardial blush grade, estimated glomerular filtration rate (eGFR), number of obstructed vessels, and OPG significantly predicted adverse cardiac events. Multiple logistic regression analysis revealed OPG as an independent predictor of MACE as well as eGFR, number of obstructed vessels, and corrected TIMI frame count. OPG, a bidirectional molecule displaying both atheroprotective and pro-atherosclerotic properties, is currently known as a marker of inflammation and a predictor of cardiovascular mortality. The present study, for the first time, demonstrated that an increased OPG level is related to in-hospital adverse cardiovascular events after primary PCI in patients with STEMI.

Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study

This study aimed to investigate the relationship of tirofiban, added to the treatment of acute ST-elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (PCI), with changes in the TIMI risk index (TRI) of TIMI flow, B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) levels. This single-center, prospective observational cohort study included 102 consecutive patients who were admitted with the diagnosis of acute STEMI (70 male; 54.9±10.4 years). Primary PCI was applied to all cases with STEMI, who applied to our hospital in the first 6 hours due to chest pain complaints. Tirofiban was administered to one group (n=55) (male: 36; 54.1±11.3 years), while the other group was not given tirofiban (n=47) (male: 34; 55.9±9.1 years). The primary end-point was TIMI flow 2 or 3 for reperfusion after primary PCI. Chi-square test, paired t-test or Wilcoxon signed rank test, Spearman correlation analysis and Kaplan-Meier survival analysis were used for statistical analysis where appropriate. BNP level remained the same in the tirofiban group, whereas a significant increase was observed in the group that was not treated with tirofiban (105.9±126.8 versus 261.3±202.3 pg/ml p<0.001). The hs-CRP level tended to rise significantly in both groups despite the treatment (tirofiban group - from 0.67±0.66 to 0.90±0.44 mg/L, p=0.015, non tirofiban group - from 0.51±0.43 to 1.08±0.74 mg/L, p<0.001). BNP and hs-CRP values remained the same in cases with TIMI 2 flow in the tirofiban group, whereas a significant increase was detected in the post-treatment BNP (before 97.8±122.3 after 281.6±217.3 pg/ml, p=0.011) and hs-CRP (before 0.65±0.69; after 1.33±0.80 mg/L, p=0.028) values in the group not treated with tirofiban. In patients with TIMI 3 flow, BNP (tirofiban group before 146.5±114.2; after 184.4±139.4 pg/ml, p=0.011, non tirofiban group before 172.1±297.9; after 295.9±384.9 pg/ml, p<0.001) and hs-CRP levels (tirofiban group before 0.66±0.58; after 0.92±0.65 mg/L, p=0.011, non tirofiban group before 0.81±0.74; after 1.45±1.23 mg/L, p<0.001) were found to be similarly reduced in both treatment groups p<0.05. Three patients with minor hemorrhage did not need blood transfusion. It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values.

Abstract 9123: Utilization of TIMI Risk Index in Determining the Need of Admission to Coronary Care Unit for Acute ST Elevation Myocardial Infarction Patient After Successful Primary Percutaneous Coronary Intervention: Single Centre Study

Introduction: With the ever-increasing number of acutely ill patients with cardiac disease that need intensive monitoring and limited resources in coronary care unit (CCU), there is a need to ensure appropriate admission to CCU. TIMI risk index (TRI) was a robust predictor (for STEMI patients on first arrival in hospital) and high discriminatory capacity of in-hospital events. TRI was divided into five risk groups with the higher the index score, the higher the mortality. We attempt to study TIMI risk index {TRI = [heart rate X (age/10)2]/systolic blood pressure} in determining the need of admission to CCU for STEMI patient after successful primary percutaneous coronary intervention (PPCI). Methods: This was a retrospective study over 12 months period. Inclusion criterias including patient presented with STEMI at emergency department and underwent successful PPCI which defined as achieving TIMI 3 flow. Exclusion criterias include no documentation of blood pressure and/or heart rate at presentation at emergency department. Study end point was in-hospital major adverse cardiovascular events (MACE) that include all cause death including cardiac death, target lesion revascularization, recurrent myocardial infarction, stroke, in-stent thrombosis. Results: A total of 275 patients had STEMI and underwent PPCI. 16 patients were excluded (13 patients did not have heart rate and/or blood pressure documented at presentation and 3 patients had unsuccessful PPCI). Majority was male (85.3%) and had anterior STEMI (51.0%). In the first two groups (risk group 1 and risk group 2), there was no in-hospital MACE as compare to the last two groups (risk group 4 and risk group 5), in which the in-hospital MACE was &gt;10% (12.2% and 17.0% respectively, p=0.001). The in-hospital mortality was high in the last two groups (9.8% and 13.2% respectively) as compare to no in-hospital mortality in the first two groups, p=0.004. Non of the patients in risk group 1 and 2 required intra-aortic balloon counterpulsation. Conclusions: Patients presented with acute STEMI with TRI &lt;17.5 at presentation and underwent successful PPCI for STEMI did not encounter any in-hospital MACE and may probably benefit from observation in step-down unit and the implication may result in substantial cost savings.

The effect of streptokinase therapy in STEMI and conventional therapy in NSTEMI patients on TIMI risk index, B-type natriuretic peptide and high-sensitive C-reactive protein

In this study, it was aimed to investigate the effect of streptokinase therapy in ST elevation myocardial infarction (STEMI) and conventional therapy in non-ST elevation myocardial infarction (NSTEMI) patients on the thrombolysis in myocardial infarction (TIMI) risk index (TRI), B-type natriuretic peptide (BNP), and high-sensitive C-reactive protein (hs-CRP) levels. Eighty-six STEMI (male/female ratio: 65/21, mean age 57.52±9.87 years) and eighty NSTEMI patients (male/female ratio: 50/30, mean age 57.6±1.7 years) were included in this prospective observational study. Hs-CRP and BNP were measured and TIMI risk index was calculated in all patients. Coronary angiography was performed in all patients for principally determining TIMI flow rate. Chi-square test, paired t-test or Wilcoxon signed rank test, ANOVA and Spearman correlation analysis were used for statistical analysis where appropriate. STEMI patients had higher systolic blood pressure, heart rate, BNP and hs-CRP values than NSTEMI patients at admission (p=0.04, p=0.01, p=0.001 and p=0.01, respectively). Thrombolytic therapy in STEMI patients resulted in statistically significant higher levels of BNP, hs-CRP and TRI values compared to baseline levels (p=0.001, p=0.001 and p=0.042, respectively). For NSTEMI patients conventional therapy yielded statistically significant decrease in systolic blood pressure levels and increase in TRI (p=0.001 and p=0.047, respectively). We found significantly lower BNP, hs-CRP in patients with higher TIMI flow rate (p=0.001 and p=0.001 respectively). Thrombolytic therapy with streptokinase failed to decrease BNP, hs-CRP and TRI values in STEMI patients. Conventional therapy in NSTEMI patients also resulted in higher TRI values than baseline values. We reached TIMI 3 flow in only 10.5% of the study patients, which may be responsible for our findings.

Impact of primary PCI volume on hospital mortality in STEMI patients: does time-to-presentation matter?

The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (≤90min, >90min-180min, >180min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r=-0.9; P<0.001). High primary PCI volumes best predicted the improvement of survival when the time-to-presentation was ≤90min (area under the curve=0.73, P<0.0001). At this time, the best primary PCI threshold to provide benefit was >66 primary PCIs/year (OR=0.21 [95% CI 0.10-0.47], P<0.001) and those with high TIMI Risk Index achieved the greatest benefit (P<0.001). At >90min-180min, the model was less significant (P=0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to-presentation >180min (P=0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90min from symptoms onset.

COMPARING UTILIZATION OF TIMI RISK INDEX VERSUS KILLIP CLASS AT PRESENTATION IN DETERMINING THE NEED OF ADMISSION TO CORONARY CARE UNIT FOR ACUTE ST ELEVATION MYOCARDIAL INFARCTION PATIENT AFTER SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION: SINGLE CENTRE STUDY

Background: With the ever-increasing number of acutely ill patients with cardiac disease that need intensive monitoring and limited resources in coronary care unit (CCU), there is a need to ensure appropriate admission to CCU. Studies have shown that Killip 1 patients who had successful primary percutaneous coronary intervention (PPCI) for ST Elevation Myocardial Infarction (STEMI) can be admitted safely to a step-down unit. However, Killip class was a subjective assessment. We attempt to compare TIMI risk index {TRI = [heart rate X (age/10)2]/systolic blood pressure} versus Killip Class at presentation in determining the need of admission to CCU for STEMI patient after successful PPCI. TRI was a robust predictor (for STEMI patients on irst arrival in hospital) and high discriminatory capacity of in-hospital events in each of the ive risk subgroups.

Highlights of the first Malaysian National Cardiovascular Disease Database (NCVD): Percutaneous Coronary Intervention (PCI) Registry

Summary Objective The Malaysian NCVD-PCI registry attempts to determine the number and to monitor the outcomes of Percutaneous Coronary Intervention (PCI), based on selected performance indicators. It provides a comprehensive view to determine the level of adherence to existing guidelines, to evaluate the cost-effectiveness of treatment and prevention programs and to facilitate quality improvement activities of the participants. It also aims to stimulate research and to act as a reference for future studies. Methods It was a voluntary, multi-centered, observational, cohort study and included patients of 18 years or above, with coronary artery disease who underwent PCI at eight participating centers in the year 2007. Results A total of 3677 patients underwent 3920 PCI procedures with 6299 stents for 5512 lesions. The mean age of patients was 56.7 ± 10.11 years. The mean BMI was 26.38 ± 4.21 kg/m2, while 80% of all subjects had a BMI above 23 kg/m2. Males constituted 81.2% of the total population and 98.4% of the total population had at least one cardiovascular risk factor. Regarding PCI status, 90.1% were elective cases and 94% of cases had a low TIMI risk index at the beginning of PCI. Femoral approach accounted for 59%, radial approach for 34% and brachial approach for 1% of all cases. The median fluoroscopy time was 15.7 min and the median door-to-balloon time for primary infarct PCI was 93.5 min. The commonest site of lesion was the left anterior descending artery, accounting for 48% of all lesions and 92.8% of all lesions were de novo. The mean lesion length was 24.4 ± 15.18 mm and about 28% of all lesions had high risk characteristics. Drug-eluting stents and bare metal stents were used in 53.6% and 42.5% of cases, respectively. After PCI, 91% of all lesions achieved TIMI grade 3 flow. Regarding pharmacotherapy, 99.5% of all patients received unfractionated heparin, 5% received LMWH prior to intervention, 96% received aspirin and 98% received clopidogrel. Over-all in-hospital mortality and 30 day mortality for the entire cohort was 1.1% and 1.8%, respectively. Conclusion A summary of the first nationwide PCI registry has been presented. The subjects were much younger with a high prevalence of cardiovascular risk factors. The majority of cases (90%) were elective procedures with a low TIMI risk index. Mean door-to-balloon time for primary PCI was higher than the recommended guidelines. There was good prescribing of antiplatelets and heparin. Over-all in-hospital and 30 day mortality were comparable to other registries.

Identification of predictors of inhospital postreperfusion mode of death in patients with acute ST-elevation myocardial infarction

OBJECTIVES. The aim of this study was to identify the predictors of the postreperfusion mode of death using the distinctions in clinical characteristics of patients who died and survived after reperfusion therapy, treated due to ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS. This consecutive study has involved 36 patients: 18 patients who died from progressive heart failure (PHF) (group 1, n=13) or from cardiac rupture (CR) (group 2, n=5) after primary coronary intervention. The control group consisted of 18 randomly selected patients who survived in-hospital period (group 3). The initial and postreperfusion heart rate (HR), systolic and diastolic arterial pressures (SAP and DAP), maximal ST elevation (max ST upward arrow) and depression (max ST downward arrow), ST score, TIMI flow grade, coronary score (CS), and their perireperfusion changes were assessed for each patient. The complex prognostic predictors--TIMI Risk Score and TIMI Risk Index--were also assessed. The data analysis was performed by standard statistical and machine learning approach methods. RESULTS. The comparison of three patients' groups according to simple ECG or circulatory characteristics showed that more significant differences were seen in postreperfusion characteristics or their perireperfusion changes. Herewith, the major part of significantly different characteristics (baseline SAP, DAP, and HR, postreperfusion SAP, DAP, ST score, and TIMI flow grade, resolution of ST score) was observed comparing both the groups of dead patients with survivors (control group). The differences in the complex predictors (TIMI Risk Score and TIMI Risk Index) were similar. However, the smallest number of significantly different characteristics was seen comparing both the groups of dead patients. The baseline DAP (P=0.045), postreperfusion SAP (P=0.04) and DAP (P=0.03), and ST score (P=0.0025) were higher in the patients who died from CR. The postreperfusion ST score and SAP were also identified as necessary components in the assessment of informative prognostic sets according to feature selection methods used in data mining field. CONCLUSION. The postreperfusion ST score, SAP, and DAP could be useful for the prediction of in-hospital postreperfusion mode of death in patients with STEMI; evidently more clinical predictors could be useful for the prediction of general occurrence of postreperfusion deaths.

Prognostic Implications of ST-Segment Elevation Resolution in Patients With ST-Segment Elevation Acute Myocardial Infarction Treated With Primary or Facilitated Percutaneous Coronary Intervention

Scant data are available on the relation between ST-segment elevation (STE) resolution and 30-day mortality in patients with STE acute myocardial infarction treated with percutaneous coronary intervention in contemporary, real world, clinical practice. Furthermore, whether the prognostic value of STE resolution is influenced by the patient clinical risk profile or postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow has never been investigated. Lombardima was an observational registry implemented in Lombardy, a Northern Italian region. The clinical characteristics, electorcardiographic parameters, and procedural data were prospectively entered into a Web-based database. In the present study, we enrolled 3,403 patients. STE resolution occurred in 2,452 patients (group 1) and did not in 951 patients (group 2). The mortality rate was 2.4% in group 1 and 11.3% in group 2 (p <0.001). After stratifying patients according to their TIMI risk index, we observed that STE resolution was an independent predictor of 30-day mortality across all spectrum of clinical risk. Furthermore, in patients with TIMI 3 flow, STE resolution remained an independent predictor of 30-day mortality (p <0.0001). In conclusion, STE resolution was a strong and independent predictor of 30-day mortality in patients with STE acute myocardial infarction undergoing percutaneous coronary intervention across all spectrum of clinical risk.

A new risk score system for the assessment of clinical outcomes in patients with non-ST-segment elevation myocardial infarction

Prediction for long-term clinical outcomes in patients with non-ST elevation acute coronary syndrome is important as well as early risk stratification. The aim of this study is to develop a simple assessment tool for better early bedside risk stratification for both short- and long-term clinical outcomes. 2148 patients with non-ST-segment elevation myocardial infarction (NSTEMI) (64.9±12.2years, 35.0% females) were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR). A new risk score was constructed using the variables related to one year mortality: TIMI risk index (17.5-30: 1 point, >30: 2 points), Killip class (II: 1 point, >II: 2 points) and serum creatinine (≥1.5mg/dL: 1 point), based on the multivariate-adjusted risk relationship. The new risk score system was compared with the Global Registry of Acute Coronary Events (GRACE) and TIMI risk scores during a 12-month clinical follow-up. During a one year follow-up, all causes of death occurred in 362 patients (14.3%), and 184 (8.6%) patients died in the hospital. The new risk score showed good predictive value for one year mortality. The accuracy for in-hospital and one year post-discharge mortality rates, the new risk score demonstrated significant differences in predictive accuracy when compared with TIMI and GRACE risk scores. A new risk score in the present study provides simplicity with accuracy simultaneously for early risk stratification, and also could be a powerful predictive tool for long-term prognosis in NSTEMI.