Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Satou ◽  
H Kitahara ◽  
K Ishikawa ◽  
T Nakayama ◽  
Y Fujimoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Short Term ◽  
Recurrent Myocardial Infarction ◽  
St Elevation

Abstract Background The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients. Purpose To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients. Methods Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected. Results In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p<0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups. Conclusions In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients. Initial event occurrence timing Funding Acknowledgement Type of funding source: None

scholarly journals Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

scholarly journals Immune‐related Long Noncoding RNA Signature for Patients with Cervical Cancer

2020 ◽  
Author(s):  
Jianfeng Zheng ◽  
Jinyi Tong ◽  
Benben Cao ◽  
Xia Zhang ◽  
Zheng Niu
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Risk Score ◽  
Immune Cell ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Gene Set Enrichment Analysis ◽  
Training Set ◽  
Score Model

Abstract Background: Cervical cancer (CC) is a common gynecological malignancy for which prognostic and therapeutic biomarkers are urgently needed. The signature based on immune‐related lncRNAs(IRLs) of CC has never been reported. This study aimed to establish an IRL signature for patients with CC.Methods: The RNA-seq dataset was obtained from the TCGA, GEO, and GTEx database. The immune scores（IS）based on single-sample gene set enrichment analysis (ssGSEA) were calculated to identify the IRLs, which were then analyzed using univariate Cox regression analysis to identify significant prognostic IRLs. A risk score model was established to divide patients into low-risk and high-risk groups based on the median risk score of these IRLs. This was then validated by splitting TCGA dataset(n=304) into a training-set(n=152) and a valid-set(n=152). The fraction of 22 immune cell subpopulations was evaluated in each sample to identify the differences between low-risk and high-risk groups. Additionally, a ceRNA network associated with the IRLs was constructed.Results: A cohort of 326 CC and 21 normal tissue samples with corresponding clinical information was included in this study. Twenty-eight IRLs were collected according to the Pearson’s correlation analysis between immune score and lncRNA expression (P < 0.01). Four IRLs (BZRAP1-AS1, EMX2OS, ZNF667-AS1, and CTC-429P9.1) with the most significant prognostic values (P < 0.05) were identified which demonstrated an ability to stratify patients into low-risk and high-risk groups by developing a risk score model. It was observed that patients in the low‐risk group showed longer overall survival (OS) than those in the high‐risk group in the training-set, valid-set, and total-set. The area under the curve (AUC) of the receiver operating characteristic curve (ROC curve) for the four IRLs signature in predicting the one-, two-, and three-year survival rates were larger than 0.65. In addition, the low-risk and high-risk groups displayed different immune statuses in GSEA. These IRLs were also significantly correlated with immune cell infiltration. Conclusions: Our results showed that the IRL signature had a prognostic value for CC. Meanwhile, the specific mechanisms of the four-IRLs in the development of CC were ascertained preliminarily.

A Risk Score to Predict CMV Viremia within the First 100 Days after Allogeneic Stem Cell Transplantation Based on Pre-Transplant Parameters

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3877-3877
Author(s):  
Feras Alfraih ◽  
John Kuruvilla ◽  
Naheed Alam ◽  
Anna Lambie ◽  
Vikas Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Cmv Infection ◽  
Allogeneic Hsct ◽  
Very High

Abstract Introduction: Cytomegalovirus (CMV) is a major infectious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Risk of CMV infection varies between patients and individualized strategies for monitoring and therapy for CMV are needed. In this study, we attempted to establish a clinical score based on patient and transplant characteristics in order to predict the probability for early CMV viremia (CMV-V) within the first 100 days after HSCT. Methods: A total of 548 patients were evaluated after receiving HSCT between 2005 and 2012 at Princess Margaret Cancer Centre. CMV sero-negative recipients with CMV sero-negative donors (R-D-) were excluded. CMV-V was diagnosed in peripheral blood samples obtained on two occasions either by PCR (>200 IU/ml) or antigenemia testing (>2 positive cells/100000). A total of 378 patients were included into the study. Uni- and multivariable analyses were performed to identify risk factors for CMV-V. A weighted score was assigned to each factor based on the odds ratios determined by the multivariable analysis. A total score was calculated for each patient and used for assignment into one of 4 risk categories, the low risk (score 0-1), the intermediate (score 2-3), the high (score 4-5) and the very high (score 6-8). Median age for all patients was 51 years (range 17-71) and 173 (46%) were female. Matched related donors were used for two hundred fifteen patients (57%). Two hundred forty-three patients (64%) were transplanted for myeloid and 108 (29%) for lymphoid malignancies. One hundred thirteen patients (30%) were CMV sero-positive with a negative donor (R+D-) while 191 (51%) were recipient and donor CMV sero-positivity (R+D+). Graft versus host disease (GVHD) prophylaxis included CSA/MMF (n=200, 52%), and CSA/MTX (n=178, 48%). Myeloablative conditioning regimens were administered to 220 patients (58%), 158 patients (42%) were treated with a reduced intensity regimen. Three hundred-thirty seven patients (89%) received peripheral blood stem cells as a stem cell source. In vivo T cell depletion (TCD) with alemtuzumab was used in 138 (37%). Results: CMV-V occurred in 246 (64%) patients by day 100 post HSCT. The impact of patient and HSCT characteristics on the risk of CMV-V was assessed by multivariable analysis. The significant factors were CMV sero-status R+D- and R+D+, TCD, GVHD prophylaxis with MMF administration of myeloablative preparative regimens (Table 1). Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT CMV-V rates on the 4 new risk categories amounted to 93% in the very high-risk, 78% in high-risk, 41% in intermediate-risk and 11% in low-risk group (Fig 1). The risk score was also predictive for the occurrence of multiple CMV-V reactivations with rates of 71%, 45%, 19% and 4% for the very high, high, intermediate and low-risk groups, respectively. The overall survival (OS) rate at 2 years was 33%(n=56) in the very high-risk group compared to 50% in other-risk groups (n=147) (P=0.01) (Fig 2). Non-relapse mortality (NRM) was 53% in the very high-risk versus 33% in other-risk groups (P<0.001). However, there was no difference on cumulative incidence of relapse between the groups (P=0.3). The cumulative incidence of grades 1-4 acute GVHD, grades 2-4, grades 3-4 at day 120 and overall chronic GVHD at 2 years was 68%, 47%, 25% and 39% in very high-risk group versus 65%, 52%, 21% and 52% in other-risk groups, suggesting slightly lower incidence of chronic GVHD in very high-risk vs other-risk groups. Conclusion: We present a new clinical scoring system to stratify the risk of early CMV viremia after allogeneic HSCT based on patients and HSCT characteristics. Identifying the risk for each patient would facilitate decision making with respect to strategies including CMV prophylaxis, pre-emptive treatment or inclusion into clinical trials, as well directing the CMV monitoring policy post-transplant. In addition, the risk score was associated with higher risk of overall mortality and NRM in the very high-risk versus other-risk groups. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Ferroptosis and Pyroptosis Molecular Subtype-Related Signature Applicable for Prognosis and Immune Microenvironment Estimation in Hepatocellular Carcinoma

2021 ◽  
Vol 9 ◽  
Author(s):  
Junyu Huo ◽  
Jinzhen Cai ◽  
Ge Guan ◽  
Huan Liu ◽  
Liqun Wu
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Molecular Subtype ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Type I ◽  
Immune Microenvironment ◽  
Risk Patients

Background: Due to the heterogeneity of tumors and the complexity of the immune microenvironment, the specific role of ferroptosis and pyroptosis in hepatocellular carcinoma (HCC) is not fully understood, especially its impact on prognosis.Methods: The training set (n = 609, merged by TCGA and GSE14520) was clustered into three subtypes (C1, C2, and C3) based on the prognosis-related genes associated with ferroptosis and pyroptosis. The intersecting differentially expressed genes (DEGs) among C1, C2, and C3 were used in univariate Cox and LASSO penalized Cox regression analysis for the construction of the risk score. The median risk score served as the unified cutoff to divide patients into high- and low-risk groups.Results: Internal (TCGA, n = 370; GSE14520, n = 239) and external validation (ICGC, n = 231) suggested that the 12-gene risk score had high accuracy in predicting the OS, DSS, DFS, PFS, and RFS of HCC. As an independent prognostic indicator, the risk score could be applicable for patients with different clinical features tested by subgroup (n = 26) survival analysis. In the high-risk patients with a lower infiltration abundance of activated B cells, activated CD8 T cells, eosinophils, and type I T helper cells and a higher infiltration abundance of immature dendritic cells, the cytolytic activity, HLA, inflammation promotion, and type I IFN response in the high-risk group were weaker. The TP53 mutation rate, TMB, and CSC characteristics in the high-risk group were significantly higher than those in the low-risk group. Low-risk patients have active metabolic activity and a more robust immune response. The high- and low-risk groups differed significantly in histology grade, vascular tumor cell type, AFP, new tumor event after initial treatment, main tumor size, cirrhosis, TNM stage, BCLC stage, and CLIP score.Conclusion: The ferroptosis and pyroptosis molecular subtype-related signature identified and validated in this work is applicable for prognosis prediction, immune microenvironment estimation, stem cell characteristics, and clinical feature assessment in HCC.

scholarly journals Correlation between Timi Risk Score and Clinical Outcome in Patients with Unstable Angina Pectoris

2016 ◽  
Vol 17 (2) ◽  
pp. 93-98
Author(s):  
Zorica Savovic ◽  
Violeta Iric-Cupic ◽  
Goran Davidovic
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Risk Score ◽  
Risk Group ◽  
Short Term ◽  
Timi Score ◽  
Poor Outcomes ◽  
Timi Risk Score

Abstract Given Taking that the TIMI score is a major predictor of MACE, this study aimed to determine the value of the TIMI risk score in predicting poor outcomes (death, myocardial infarction, recurrent pain) in patients presenting with unstable angina pectoris in short-term observation. A total of 107 patients with APns were examined at the Clinical Centre Kragujevac and were included in the investigation. The TIMI score was determined on the first day of hospitalization. During hospitalization, the following factors were also observed: troponin, ECG evolution, further therapy (pharmacologic therapy and/or emergency PCI or CABG), age, hypertension and hyperlipidaemia. The low-risk group (TIMI 0 - 2) included 30.8% of patients, whereas 47.6% of patients were in the intermediate-risk group (TIMI 3 - 4), and 21.5% of patients were in the high-risk group (TIMI 5 - 7). Good outcomes (without adverse event) and poor outcomes (death, myocardial infarction, and recurring chest pain) were dependent on the TIMI risk score. The increase in TIMI risk score per one unit increased the risk of a poor outcome by 54%. Troponin and TIMI risk score were positively correlated. Our results suggest that the TIMI risk score may be a reliable predictor of a poor outcome (MACE) during the short-term observation of patients with APns. Moreover, patients identified as high-risk benefit from early invasive PCI, enoxaparin and Gp IIb/IIIa inhibitors. Th us, routine use of the TIMI risk score at admission may reduce the number of patients not recognized as high-risk.

Clinical assessment and angiographic finding in patients with non ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Elbeyali
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
St Elevation Myocardial Infarction ◽  
Intermediate Risk ◽  
Coronary Syndrome ◽  
Clinical Risk ◽  
St Elevation

Abstract Background Non ST-elevation myocardial infarction is considered the intermediate form of acute coronary syndrome between unstable angina and ST-elevation myocardial infarction. Blockage either occurs in a minor coronary artery or causes partial obstruction of a major coronary artery. The rate of NSTEMI has increased to be 50% of all acute coronary syndrome. Purpose To compare some demographic, clinical risk assessments and angiographic data among high, intermediate and low risk NSTEMI patients. Methods We classified one hundred twenty (120) NSTEMI patients into 3groups by GRACE risk score (high risk group &gt;140, intermediate risk group from 109 to 140 and low risk group ≤108). The patients were evaluated by personal history taking, risk factors, clinical examination, ECG, laboratory investigations, echocardiography and percutaneous coronary intervention. Results We found that low risk group percentage was 47.5%, intermediate risk group percentage was 32.5% and high-risk group percentage was 20%. As regarding culprit lesion, LAD represent most affected artery (48.3% of patients).Recurrent ischemia and MI represent the highest percentage of major adverse cardiac event (MACE) among studied groups. All patients with LM disease have a MACE while 41.2% of MACE patients have significant LAD lesion. As time of intervention delayed the incidence of MACE increases among different groups. High risk group has significantly high percentage of type C lesion and TIMI 0/1 while type A lesion and TIMI III lesion highest among low risk patients. As regarding contour of the lesion, the irregularity increases as the clinical risk increases. Also as regarding occlusion of culprit artery, the incidence of total occlusion increases as the clinical risk increases. Conclusions We recommend selection of high-risk NSTEMI patient to direct them for early invasive therapy. Very high-risk directed for immediate revascularization like STEMI patient. NSTEMI considered precursors to STEMI and an early warning signal that aggressive medical intervention needed. Association between time to intervention Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University budget

scholarly journals The Cadillac Risk Score Accurately Identifies Patients at Low Risk for In-Hospital Mortality and Adverse Cardiovascularevents Following St Elevation Myocardial Infarction.

2021 ◽  
Author(s):  
Ryan S. Wilson ◽  
Peter Malamas ◽  
Brent Dembo ◽  
Sumeet K Lall ◽  
Ninad Zaman DO ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Odds Ratio ◽  
Risk Group ◽  
Low Risk ◽  
St Elevation Myocardial Infarction ◽  
Clinical Events ◽  
St Elevation ◽  
Event Rates

Abstract Background: The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods: We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk group versus intermediate to high risk group. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization. Results: The study included 314 patients. It was found that patients with a low CADILLAC score had significantly lower adverse clinical events compared to the intermediate-high CADILLAC score group (10/213 (4.7%) vs. 15/128 (11.7%), odds ratio = 0.37, 95% CI 0.16-0.85, p= 0.028). Additionally, patients with a low CADILLAC score had significantly lower adverse clinical event rates at 30 day and 1 year follow up. The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. ROC curve predicting in hospital event rate showed CADILLAC (C=0.66, odds ratio 1.18; 95% CI 1.04 - 1.33; p=0.0064). Conclusion: Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower event rates when compared to those with an intermediate-high CADILLAC score.

scholarly journals A Novel Model of Tumor-Infiltrating B Lymphocyte Specific RNA-Binding Protein-Related Genes With Potential Prognostic Value and Therapeutic Targets in Multiple Myeloma

2021 ◽  
Vol 12 ◽  
Author(s):  
JingJing Zhang ◽  
Pengcheng He ◽  
Xiaoning Wang ◽  
Suhua Wei ◽  
Le Ma ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
B Cell ◽  
Risk Score ◽  
Drug Sensitivity ◽  
Rna Binding ◽  
Risk Model ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk

Background: RNA-binding proteins (RBPs) act as important regulators in the progression of tumors. However, their role in the tumorigenesis and prognostic assessment in multiple myeloma (MM), a B-cell hematological cancer, remains elusive. Thus, the current study was designed to explore a novel prognostic B-cell-specific RBP signature and the underlying molecular mechanisms.Methods: Data used in the current study were obtained from the Gene Expression Omnibus (GEO) database. Significantly upregulated RBPs in B cells were defined as B cell-specific RBPs. The biological functions of B-cell-specific RBPs were analyzed by the cluster Profiler package. Univariate and multivariate regressions were performed to identify robust prognostic B-cell specific RBP signatures, followed by the construction of the risk classification model. Gene set enrichment analysis (GSEA)-identified pathways were enriched in stratified groups. The microenvironment of the low- and high-risk groups was analyzed by single-sample GSEA (ssGSEA). Moreover, the correlations among the risk score and differentially expressed immune checkpoints or differentially distributed immune cells were calculated. The drug sensitivity of the low- and high-risk groups was assessed via Genomics of Drug Sensitivity in Cancer by the pRRophetic algorithm. In addition, we utilized a GEO dataset involving patients with MM receiving bortezomib therapy to estimate the treatment response between different groups.Results: A total of 56 B-cell-specific RBPs were identified, which were mainly enriched in ribonucleoprotein complex biogenesis and the ribosome pathway. ADAR, FASTKD1 and SNRPD3 were identified as prognostic B-cell specific RBP signatures in MM. The risk model was constructed based on ADAR, FASTKD1 and SNRPD3. Receiver operating characteristic (ROC) curves revealed the good predictive capacity of the risk model. A nomogram based on the risk score and other independent prognostic factors exhibited excellent performance in predicting the overall survival of MM patients. GSEA showed enrichment of the Notch signaling pathway and mRNA cis-splicing via spliceosomes in the high-risk group. Moreover, we found that the infiltration of diverse immune cell subtypes and the expression of CD274, CD276, CTLA4 and VTCN1 were significantly different between the two groups. In addition, the IC50 values of 11 drugs were higher in the low-risk group. Patients in the low-risk group exhibited a higher complete response rate to bortezomib therapy.Conclusion: Our study identified novel prognostic B-cell-specific RBP biomarkers in MM and constructed a unique risk model for predicting MM outcomes. Moreover, we explored the immune-related mechanisms of B cell-specific RBPs in regulating MM. Our findings could pave the way for developing novel therapeutic strategies to improve the prognosis of MM patients.

scholarly journals Study of in-hospital outcome in acute myocardial infarction in correlation with thrombolysis in myocardial infarction risk score

2019 ◽  
Vol 7 (6) ◽  
pp. 2377
Author(s):  
Pravin Shingade ◽  
Vinay Meshram ◽  
Umesh Madavi
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Moderate Risk ◽  
Hospital Outcome ◽  
Timi Risk Score

Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score is purportedly an integral score for mortality risk prediction in fibrinolysis-eligible patients with STEMI. Attempt was made to evaluate the same by correlating risk stratification by TIMI score with hospital outcome of such patients.Methods: There were 145 cases of STEMI were studied and TIMI risk scores were calculated and analysed vis-à-vis various relevant parameters. The patients were divided into three risk groups: ‘low-risk’, ‘moderate-risk’ and ‘high-risk’ based on their TIMI scores. All patients received routine anti-ischemic therapy and were thrombolysed subsequently, monitored in ICCU and followed during hospital stay for occurrence of post-MI complications.Results: There were 79 patients (54.5%) belonged to low-risk group, 48 (33.1%) to moderate-risk group and 18 (12.4%) to high-risk group according to TIMI risk score. The mortality (total 17 deaths) was observed to be highest in the high-risk group (55.6%), followed by moderate-risk (12.2%) and low-risk group (1.28%) respectively. Out of the 7 potentially suspect variables studied, Killips classification grade 2-4 had the highest relative risk (RR-15.85), followed by systolic BP <100mmHg (RR- 10.48), diabetes mellitus (RR- 2.79) and age >65 years (RR- 2.59).Conclusions: The TIMI risk scoring system seems to be one simple, valid and practical bed side tool in quantitative risk stratification and short-term prognosis prediction in patients with STEMI.

The Added Value of ST-Elevation in Lead aVR to Clinical TIMI Score in Predicting the Angiographic Severity of Coronary Artery Disease in Patients with Non ST-Elevation Myocardial Infarction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Abobakr Fawzy Elfahham ◽  
Shehab Adel El Etriby ◽  
Ahmed Mohamed Abdelsalam ◽  
Omar Awad
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Risk Groups ◽  
Low Risk ◽  
St Segment Elevation ◽  
Timi Score ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation ◽  
Artery Disease

Abstract Background Atherosclerosis is the ongoing process of plaque formation involving primarily the intima of large and medium-sized arteries. The condition progresses relentlessly throughout a person’s lifetime, before finally manifesting itself as an acute ischemic event. TIMI score is a tool of 7 points for patients with NSTE-ACS to detect the risk according to the score. The term acute coronary syndrome (ACS) includes unstable angina (UA), non STsegment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Aim To investigate the added value of the presence of ST-segment elevation in lead avR on admission electrocardiogram to the (TIMI) clinical scoring system in predicting the angiographic severity of coronary artery disease in patients admitted with NSTE-ACS. Patients and Methods 150 patients with Non ST-segment elevation acute coronary syndrome was included from Cardiology Department, Ain Shams University Hospital, Cairo, Egypt. Results From those patients, 137 patients (91.3%) diagnosed by coronary angiography to have significant CAD and 93 patients (62%) had ST-Elevation in lead aVR . These 137 patients were divided into 3 groups according to TIMI risk score to 16 patients (10.6%) had low risk score, 63 patients (42.0%) had intermediate risk & lastly 58 patients (38.7%) had high risk score. . Although being useful in prediction of multi-vessel & LM involvement among high risk group, TIMI score failed to predict the same in intermediate & low risk groups where multi-vessel involvement was found in 46 patients (30.6%) & 7 patients (4.6%) of intermediate & low risk groups respectively. Also LM involvement was found in 15 patients (10%) & 2 patients (1.3%) of intermediate & low risk groups respectively. Conclusion ST-segment elevation (STE) in lead avR had an adding predicting value in NSTEACS patients especially those with low to intermediate TIMI score. Adding the value of STE in lead aVR to TIMI risk score may improve the early stratification & management of those patients at high risk coronary artery disease, with subsequent impact on morbidity & mortality.

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