ABSTRACT
Background: Non-ST elevation acute coronary syndrome (NSTE-ACS) patients are complex and varied population. Primarily thrombolysis in myocardial infarction (TIMI) risk score was developed to guide therapy and assess the short term (14 days) prognosis of these patients. However, few studies have evaluated the long term prognostic significance of TIMI risk score after revascularization. This study aims at assessing the long term prognostic significance of TIMI risk score, 36 months after revascularization in NSTE-ACS.Methods: This was a retrospective observational cohort study of consecutive NSTE-ACS patients (n=150) treated by percutaneous coronary intervention between January 2017 to June 2017 in a tertiary care center. TIMI risk score was calculated for each patient at admission. The primary endpoint was a composite of MACE (death, repeat target-vessel revascularization, and non-fatal recurrent MI) at the end of 36 months of follow up. Clinical secondary endpoints included the individual components of the primary endpoint, death, nonfatal recurrent MI, and repeat target vessel revascularization.Results: Baseline characteristics for 150 participants were as follows, age 56±9.5 years, 78.7% male, 25% diabetics, 82% hypertensives, and 36% had hypercholesterolemia. The event rates of the primary endpoint and its components after 36 months were 26.6%. Event rates increased significantly as the TIMI risk score increased as determined by regression analysis (p=0.004). The relative risk increased by 66% as the TIMI risk score increased from low risk category (TIMI score 0-2) to high risk (TIMI score 5-6).Conclusions: TIMI risk score can be used for long term prognostication of NSTE-ACS patients after revascularization, and thus can be used by clinicians for therapeutic decision making.
ABSTRACT
Objectives:The purpose of this study was to evaluate the prognostic value of the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores for in-hospital mortality in Chinese ST-segment elevation myocardial infarction (STEMI) patients. Methods:Present data are obtained from the prospective, multicenter Chinese AMI (CAMI) registry, 107 hospitals from 31 provinces, municipalities or autonomous districts in China took part in this study. From January 2013 to September 2014, 17886 consecutive ST-segment elevation myocardial infarction patients admitted to these 107 hospitals were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value on the primary endpoint (in-hospital mortality) was evaluated. Results:Mean age of this patient cohort was (61.9±12.4)years, 76.5% (n=13685) patients were males. The in-hospital mortality was 6.4%(n=1 153)and the median length of hospital stay was 10.0 days. The incidence of cardiac arrest at admission were 4.3% (n=764). Coronary reperfusion therapy including fibrinolytic therapy(n=1782), primary percutaneous coronary intervention (n=7763) and emergent coronary artery bypass grafting (n=10) were applied to 9555 (53.4%) patients and the median of time to reperfusion was 300.0 minutes. The predictive accuracy of TIMI and GRACE for in-hospital mortality was similar:TIMI risk score (AUC) [area under the curve:0.7956; 95% confidence interval (95%CI:0.7822~0.8090)] and GRACE risk score (AUC:0.8096; 95%CI:0.7963~0.8230). Conclusions:The TIMI and GRACE risk score demonstrate similar predictive accuracy for in-hospital mortality and there are some disadvantages in risk stratification by these two risk scores for Chinese STEMI patients.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the intervention effects of acupuncture combined with standardized treatment of western medicine on blood-stasis syndrome in unstable angina (UA) patients with different thrombolysis in myo-cardial infarction (TIMI) risk stratification.</p><p><b>METHODS</b>According to TIMI risk score, a total of 72 UA patients were included, 24 cases in low-risk (0 to 2 points) group, 24 cases in moderate-risk (3 to 4 points) group and 24 cases in high-risk (5 to 7 points) group. Based on routine standardized treatment of western medicine, acupuncture was applied at Xinshu (BL 15), Xuehai (SP 10), Geshu (BL 17), Danzhong (CV 17), Jueyinshu (BL 14), Ximen (PC 4) and Neiguan (PC 6) in three groups. Acupuncture was given once a day, 14 days as a session. After one session, each symptom score and total score of blood stasis syndrome were observed.</p><p><b>RESULTS</b>One patient dropped out respectively, and 23 patients in each group were included in the analysis. After treatment, the score of angina symptom and total score of blood stasis syndrome were significantly improved in three groups (all<0.01). The improvements of each score and total score of blood stasis syndrome in the high-risk group were superior to those in the low-risk group and moderate-risk group (<0.05,<0.01).</p><p><b>CONCLUSIONS</b>With the higher TIMI scores, the blood stasis syndrome is aggravated accordingly. Acupuncture combined with standardized treatment of western medicine could effectively intervene blood stasis syndrome, especially for the score of blood stasis syndrome of patients in high-risk group.</p>
ABSTRACT
As doenças cardiovasculares, principal causa de morte em nosso país e na maioria dos países, resultam de diversos fatores de risco. O infarto agudo do miocárdio apresenta-se de duas maneiras: com supradesnivelamento do segmento ST (IAMCSST) e sem supradesnivelamento do segmento ST (IAMSSST). A abordagem terapêutica do IAMSSST baseia-se na estratificação de risco, podendo ser realizada através do escore TIMI. O objetivo desse estudo foi verificar os fatores de risco para doenças cardiovasculares e a relação entre o escore TIMI de pacientes com IAMSSST e o tempo para realização da cinecoronariografia. Estudo transversal, prospectivo com componente analítico, realizado no período de 01 de agosto de 2011 a 30 de novembro de 2011.O censo foi constituído de 97 pacientes com diagnóstico de IAMSSST. Verificou-se que a maioria dos pacientes era do sexo masculino (56,7%). A idade média dos pacientes foi de 63 anos, sendo a hipertensão arterial sistêmica o fator de risco mais frequente. O escore TIMI mais prevalente foi o intermediário, o tempo para realização da conduta invasiva foi o tardio e a terapêutica mais prevalente a angioplastia. Dentre o total de pacientes, 81,5% foram submetidos à cinecoronariografia, sendo que 37,9% foram submetidos precocemente e 62,1% tardiamente. A frequência de cinecoronariografia precoce foi 53% maior nos pacientes de alto risco quando comparados com os de baixo risco (p>0,05). Os principais fatores de risco para doenças cardiovasculares foram: hipertensão arterial sistêmica, dislipidemia, tabagismo, história familiar, diabetes e obesidade. Quanto maior o escore TIMI, mais precoce foi a realização da cinecoronariografia.
Cardiovascular diseases are the leading cause of deaths in our country, as well as in most countries, due to several risk factors. Acute myocardial infarction can occur in two ways: ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI). The therapeutic approach of NSTEMI based on risk-stratification can use the TIMI risk score. The objectives were to verify the risk factors for cardiovascular diseases, and the relation between the TIMI risk score of patients with NSTEMI and the time to start performing the coronary angiography. Cross-sectional, prospective analytical study made from august 01st 2011 to November 30th 2011.The census was carried out in 97 patients diagnosed with NSTEMI. It was found that most patients were men (56,7%). The average age of these patients was 63 years old, and systemic arterial hypertension was the most common risk factor. The most prevalent TIMI risk score was intermediate, delayed invasive intervention was performed and the most common therapy was angioplasty. Among the 97 patients, 81,5% were submitted to coronary angiography, from this total, 37,9% to early invasive intervention and 62,1% to delayed invasive intervention. The frequency of early coronary angiography was 53% superior in high-risk patients when compared to those of low-risk (p>0,05).The main risk factors for cardiovascular diseases were: systemic arterial hypertension, dyslipidemia, smoking, family history, diabetes and obesity. The higher the TIMI risk score, the earlier coronary angiography was performed.
ABSTRACT
Background: Thrombolysis In Myocardial Infarction (TIMI) risk score, heart rate variability (HRV) and 24hour mean heart rate all are important predictor of prognosis after ST segment elevation myocardial infarction(STEMI). Correlation among these factors has not been studied thoroughly. Methods: This study was conducted in NICVD (National Institute of Cardiovascular Diseases), Dhaka, from July 2008 to June 2009. Total 105 STEMI patients were included in the study. TIMI risk score were calculated and each patient under went 24hour Holter monitoring. SDNN for HRV and mean RR interval for mean heart rate were recorded. Results : Ninety one patients (mean age 53.9 ± 10.8 years), 86.7% were males and 14( mean age 59.8 ± 8.8 years), 13.3% were female. Stratification of subjects by TIMI risk score shows that nearly 60% had risk score in the range of 3 – 7, 17. % between 0 – 2 and 24% 8 or more than 8.SDNN and RR interval stratified by TIMI risk score demonstrates that both the variables decreases significantly with the increase of TIMI risk score. Among the TIMI risk groups SDNN values were 120.0 ± 19, 871.0 ± 20.5 and 40.9 ± 6.4 msec in mild, moderate and high risk group respectively(p=<0.001). Mean RR were 836.8 ± 121.0, 776.7 ± 130.3 and 649.7 ± 75.5 msec in low, intermediate and high risk group respectively(p<0.001). There was a significant correlation between depressed SDNN and high TIMI risk score (r=.893, p=.001). High TIMI risk score also showed a negative correlation with mean RR interval (r=-574, p<0.001). Mean RR and SDNN show a perfect linear relationship (r = 0.657, p < 0.001). Conclusion: It was observed that depressed heart rate variability and increased 24-hours mean heart rate correlates with high TIMI risk score after acute ST-elevation myocardial infarction.
ABSTRACT
PURPOSE: There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). MATERIALS AND METHODS: 2,845 patients with acute NSTEMI (65.6 +/- 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 +/- 12.6 years, 856 males) and late invasive treatment (65.3 +/- 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p or = 5 points). Conclusions: The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Age Factors , Angioplasty, Balloon, Coronary , Fibrinolytic Agents/therapeutic use , Hemodynamics/drug effects , Multivariate Analysis , Myocardial Infarction/drug therapy , Prospective Studies , Thrombolytic Therapy/methodsABSTRACT
Objective:Assessment ofthe value of B-type natriuretic peptide levels combines TIMI risk scores in predictinglate mortality in patients with ST-segment Elevation Myocardial Infarction(STEMI).Methods:345 patients with STEMI were studied.Blood was drawn and the plasma concentration of BNP was determined within 24 hours after the onset of chest pain and the patients'TIMI risk score was measured.The all-cause mortality,including cardiac and non-cardiac deaths during Long-term follow-up,was recorded.Results:Mortality was 20.0%(n=69)during a follow-up of 314?208 days.The late mortality was related to higher TIMI risk scores(P;P