Usefulness of the TIMI Risk Index in Predicting Short- and Long-Term Mortality in Patients With Acute Coronary Syndromes

doi:10.1016/j.amjcard.2005.04.059

The American Journal of Cardiology

Volume 96, Issue 6, 15 September 2005, Pages 773-777

https://doi.org/10.1016/j.amjcard.2005.04.059 Get rights and content

In a cohort of 710 patients with acute coronary syndromes (ACSs), we demonstrated that the Thrombolysis In Myocardial Infarction Risk Index—a predictor of 30-day mortality in clinical trial patients with ST-elevation myocardial infarction (STEMI)—is a strong predictor of short- and long-term mortality with good discrimination ability (c statistics 0.77 to 0.79) among all subtypes of ACSs (STEMI, non-STEMI, and unstable angina pectoris). These results verify the utility of the Risk Index in unselected patients with STEMI, broaden its application to other types of ACSs, and extend its utility to stratification of long-term mortality risk.

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Cited by (18)

A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index
2017, Journal of Critical Care
Citation Excerpt :
Also higher rates of major bleeding, intracranial hemorrhage and use of fresh frozen plasma in patients with higher TRI may attributable to higher age in these patients. TRI is a novel and cheap scoring system which was found significantly predictive for short-term and long-term mortality in some large cohorts and studies of patients with ACS [6,7,14]. ACS and PE commonly have similar precipitating and prognostic factors such as age, hypotension and tacyhcardia in admission [2,15].
Thrombolysis 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.
We 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.
In-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.
TRI 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.
Thrombolysis in myocardial infarction (TIMI) risk score remains relevant in the era of field triage of patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention
2013, International Journal of Cardiology
Thrombolysis in Myocardial Infarction (TIMI) Risk Index predicts long-term mortality and heart failure in patients with ST-elevation myocardial infarction in the TIMI 2 clinical trial
2009, American Heart Journal
Citation Excerpt :
The TRI differs in that it is a simple risk index with only 3 variables (baseline age, heart rate, and systolic BP) that can be used at initial triage in the emergency department (or even the ambulance), without the need for clinical history, laboratory analysis, or a complex integer point scale system. Its robustness has led to its validation in not only patients with STEMI1,2 but also patients with all manifestations of acute coronary syndromes.3,13,14 In our study, we tested the use of TRI on secondary end points of recurrent MI, CHF, and composite death/CHF.
TIMI (Thrombolysis in Myocardial Infarction) Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in patients with ST-elevation myocardial infarction (MI). We sought to evaluate whether TRI was predictive of long-term mortality and clinical events.
In the TIMI 2 trial, 3,153 patients (mean age 57 ± 10 years, 82% men) were randomized to invasive (n = 1,583) versus conservative (n = 1,570) strategy postfibrinolysis with median follow-up of 3 years. TIMI Risk Index was divided into 5 groups. The primary end point was all-cause mortality. Secondary analyses included recurrent MI, congestive heart failure (CHF), and combined end points.
When compared with group 1, mortality in group 5 was more than 5-fold higher (hazard ratio [HR] 5.83, P < .0001) and was also increased in group 4 (HR 2.80, P < .0001) and group 3 (HR 1.96, P = .002) (c statistic 0.69). No difference was seen between groups 1 and 2 (P = .74). A similar increasing gradient effect was seen across TRI strata with group 5 having the highest risk for CHF (HR 4.13, P < .0001) and the highest risk for composite death/CHF (HR 4.35, P < .0001) over group 1. There was no difference in recurrent MI between the groups (P = .22). After controlling for other risk indicators, the relationship between TRI and mortality remained significant: group 5, HR 4.11, P < .0001; group 4, HR 2.14, P = .0009; group 3, HR 1.69, P = .02. When stratified by TRI groups, no differences in mortality or composite death/MI were found between treatment strategies.
The simple TRI can predict increased long-term mortality, CHF, and composite death/CHF.
Prognostic significance of the admission plasma B-type natriuretic peptide measurement in patients with first ST-elevation myocardial infarction in comparison with C-reactive protein and TIMI risk score
2007, Clinica Chimica Acta
In ST-elevation myocardial infarction (STEMI) B-type natriuretic peptide (BNP) holds promise for risk stratification. Aim of this study was to assess prognostic value of plasma BNP measurement and to compare with other powerful prognostic markers — TIMI Risk Score (TRS) and C-reactive protein (CRP) in patients with first STEMI treated with primary PCI (pPCI).
86 patients, admitted within initial 12 h of the first STEMI. Admission plasma levels of BNP were measured by MEIA method. Serum levels of CRP were measured using immunoturbidimetric assays. Composite end point (CEP) was assessed after 7 months.
Median plasma BNP value was higher in patients with CEP, compared with those without CEP (p < 0.001). Patients with plasma BNP > 99.2 pg/mL were at significantly higher risk for CEP (the highest sensitivity and specificity). CRP level > 10.6 mg/dL was also associated with poor outcome. TRS has not influenced the occurrence of CEP. In the analysis of logistic regression the BNP value > 99.2 pg/mL was the strongest predictor of CEP. ROC analysis identified BNP measurement as significant to estimate adverse outcome 0.950 in the prediction of CEP (95% Confidence interval = 0.878–0.985).
Admission plasma BNP concentrations provide incremental prognostic information in patients with first STEMI treated with pPCI.
Validation of the Thrombolysis In Myocardial Infarction (TIMI) risk index for predicting early mortality in a population-based cohort of STEMI and non-STEMI patients
2007, Canadian Journal of Cardiology
The Thrombolysis In Myocardial Infarction (TIMI) risk index for the prediction of 30-day mortality was developed and validated in patients with ST-segment elevation myocardial infarction (STEMI) who were being treated with thrombolytics in randomized clinical trials. When tested in clinical registries of patients with STEMI, the index performed poorly in an older (65 years and older) Medicare population, but it was a good predictor of early death among the more representative population on the National Registry of Myocardial Infarction-3 and -4 databases. It has not been tested in a population outside the United States or among non-STEMI patients.
The TIMI risk index was applied to the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study cohort of 11,510 acute MI patients from Ontario. The model's discriminatory capacity and calibration were tested in all patients and in subgroups determined by age, sex, diagnosis and reperfusion status.
The TIMI risk index was strongly associated with 30-day mortality for both STEMI and non-STEMI patients. The C statistic was 0.82 for STEMI and 0.80 for non-STEMI patients, with overlapping 95% CI. The discriminatory capacity was somewhat lower for patients older than 65 years of age (0.74). The model was well calibrated.
The TIMI risk index is a simple, valid and moderately accurate tool for the stratification of risk for early death in STEMI and non-STEMI patients in the community setting. Its routine clinical use is warranted.
L’indice de risque TIMI (Thrombolysis In Myocardial Infarction) relativement à la prédiction de la mortalité au bout de 30 jours a été mis au point et validé chez des patients ayant subi un infarctus du myocarde (IM) avec sus-décalage du segment ST et traités par thrombolyse dans le cadre d’essais cliniques avec hasardisation. Lorsque l’indice a été vérifié dans des registres cliniques de patients ayant subi un IM avec sus-décalage du ST, celui-ci s’est révélé un mauvais prédicteur dans une population âgée (plus de 65 ans), protégée par le régime Medicare, mais s’est révélé un bon prédicteur de mortalité précoce dans une population plus représentative des patients inscrits dans les bases de données du National Registry of Myocardial Infarction 3 et 4. L’indice n’a pas été vérifié dans des populations vivant à l’extérieur des États-Unis ou chez des patients ayant subi un IM sans sus-décalage du ST.
L’indice de risque TIMI a été appliqué à une cohorte de 11 510 patients de l’Ontario, ayant subi un infarctus aigu du myocarde et participant à l’étude Enhanced Feedback for Effective Cardiac Treatment (EFFECT). La capacité discriminante du modèle et son calage ont été vérifiés chez tous les patients et dans des sous-groupes de patients déterminés selon l’âge, le sexe, le diagnostic et le degré de reperfusion.
L’indice de risque TIMI a été fortement associé à la mortalité au bout de 30 jours tant chez les patients ayant subi un IM avec sus-décalage du ST que chez ceux ayant subi un IM sans sus-décalage du ST. La valeur C statistique était de 0,82 dans les cas de sus-décalage et de 0,80 dans les cas d’absence de sus-décalage, avec chevauchement de l’intervalle de confiance à 95 %. La capacité discriminante était un peu plus faible chez les patients âgés de 65 ans et plus (0,74), mais le modèle était bien calé.
L’indice de risque TIMI est un outil simple, valide et assez précis de classification du risque de mortalité précoce chez les patients ayant subi un IM avec ou sans sus-décalage du segment ST, dans la collectivité. Son application en pratique clinique est justifiée.
Application of the Thrombolysis In Myocardial Infarction Risk Index in Non-ST-Segment Elevation Myocardial Infarction. Evaluation of Patients in the National Registry of Myocardial Infarction
2006, Journal of the American College of Cardiology
Citation Excerpt :
Despite the differences in pathophysiology and treatment of patients with STEMI and NSTEMI, the three components of the risk index have a bearing on ultimate outcome in both conditions. These findings are consistent with a previous single-center study showing the utility of the TRI across the spectrum of ACS (23). Moreover, the TRI provides a tool to identify patients with NSTEMI at high risk who may warrant intensive monitoring and care similar to that given to patients with STEMI.
The purpose of this research was to evaluate the Thrombolysis In Myocardial Infarction risk index (TRI) to characterize the risk of death among patients with non–ST-segment elevation myocardial infarction (NSTEMI).
The TRI, calculated from baseline age, systolic pressure, and heart rate, was established in patients with ST-segment elevation myocardial infarction (STEMI) and is predictive of mortality. Patients presenting with NSTEMI are increasing compared to STEMI and constitute a group with varied risk.
The TRI was calculated in 337,192 patients from the National Registry of Myocardial Infarction with NSTEMI. Values and outcomes were compared with 153,486 patients with STEMI classified by reperfusion status. Comparisons of baseline characteristics and clinical outcomes stratified by TRI were made.
There was a graded relationship between the TRI and mortality in patients with NSTEMI with a >30-fold difference in mortality rates between lowest and highest deciles (p < 0.0001). The index showed good discrimination (c = 0.73). Overall mortality in the group with NSTEMI was higher (10.9%) than patients with STEMI treated with (6.6%) but lower than for STEMI patients not receiving reperfusion therapy (18.7%). The higher risk in comparison to patients with STEMI treated with reperfusion therapy was explained largely by the higher-risk profile of the population with NSTEMI.
There is a graded relationship between TRI and mortality in patients with NSTEMI. This simple risk index provides important information about mortality in patients across the spectrum of myocardial infarction, STEMI and NSTEMI. Early identification of NSTEMI patients who are at high risk of in-hospital mortality may provide clinicians with important information for initial triage and treatment.

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Coronary artery diseaseUsefulness of the TIMI Risk Index in Predicting Short- and Long-Term Mortality in Patients With Acute Coronary Syndromes

J Am Coll Cardiol

J Clin Epidemiol

Lancet

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Coronary artery disease
Usefulness of the TIMI Risk Index in Predicting Short- and Long-Term Mortality in Patients With Acute Coronary Syndromes