The TIMI Risk Score is a simple and effective tool for risk stratification in patients (pts) with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The presence of heart failure (HF) or a low ejection fraction (EF) has also been associated with a worse outcome. We sought to evaluate the interaction of heart failure on the risk gradient defined by the TIMI Risk Score in a NSTE-ACS population. We studied 9980 pts with NSTE-ACS included in a prospective nationwide clinical registry since 2002. Pts were stratified by TIMI Risk Score in low (0 to 2), intermediate (3 and 4) and high risk (5 to 7) groups. The population was divided in two groups according to the presence or absence of HF. HF was defined as the presence of a Killip class >1 or a systolic EF <30%. In-hospital mortality or re-infarction was assessed in both groups during the index hospitalization and according to TIMI Risk Score Stratification.
Results: In-hospital mortality or re-infarction was 1,9% in low risk, 3,7% in intermediate and 6,3% in high risk pts (Qui-square trend p<0,001). The risk gradient defined by the TIMI risk score was not observed in patients without HF (Qui-Square for trend=ns). In pts with HF, the TIMI risk score maintains its predictor value (Qui-square trend=0,014), but the presence of HF identifies a higher risk subgroup. In this population, HF was a strong independent predictor for in-hospital mortality and re-infarction (OR 10,01). In NSTE-ACS pts, the presence of HF identifies the patients with higher risk for in-hospital risk and re-infarction within each TIMI Risk Score subgroup. There was no risk gradient assessed by the TIMI risk score in the absence of HF.
Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE)