Plasma markers of endothelial damage/dysfunction, inflammation and thrombogenesis in relation to TIMI risk stratification in acute coronary syndromes

2005 ◽  
Vol 94 (11) ◽  
pp. 1077-1083 ◽  
Author(s):  
Kaeng Lee ◽  
Andrew Blann ◽  
Gregory Lip
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Endothelial Damage ◽  
Cardiac Events ◽  
Short Term ◽  
Coronary Syndromes ◽  
Timi Risk Score

SummaryRisk stratification at presentation with acute coronary syndromes (ACS) on the basis of theTIMI risk score for unstable angina and non-ST-elevation myocardial infarction (UAP/NSTEMI) identifies patients at high risk of recurrent cardiac events and those who benefit from more aggressive treatment strategy. We hypothesised the following: (a) that a high TIMI risk score brings a greater degree of acute changes in endothelial damage/dysfunction (circulating endothelial cells [CECs], von Willebrand factor [vWf]), inflammation (interleukin-6, IL-6) and blood thrombogenicity (plasma tissue factor, TF); and (b) that these indices are higher in those with high TIMI risk score who experienced recurrent cardiac event at day 14 and day 30. TIMI risk scores were determined at admission and 48 hours later in 88 ACS patients (60 male, age 67±12 yrs) with UAP or NSTEMI. CECs, IL-6 andTF levels were measured at both time points and the acute change (Δ) calculated. Patients were split into high (score ≥4) or low (<4) TIMI score groups. The composite end point of death, myocardial infarction, and refractory angina requiring revascularisation following 14 and 30 days’ follow-up was ascertained. Fifty-eight patients with high TIMI risk score (mean 4.7) had significantly higher baseline and 48 h CEC, vWf, IL-6, TF and ΔTF levels, compared to low TIMI risk score (mean 2.4) patients (all p<0.05). Multivariate Cox regression analysis adjusted for clinical variables and TIMI risk score expressed as either continuous or categorical variable identified baseline CECs and ΔvWf levels (both p≤0.01) as independent predictors of subsequent cardiac events at both 14 days and 30 days. TIMI risk score for UA/NSTEMI identifies those patients with more profound vascular insult, inflammation and thrombogenicity that, in the ‘high risk’ patient group, predicts short-term outcomes although vascular damage was the more sensitive predictor. These indices may further refine global risk stratification for short-term adverse cardiac events in these patients.

Abstract 5584: Heart Failure Eliminates the Risk Gradient Defined by TIMI Risk Score in Non-st-segment Elevation Acute Coronary Syndromes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sara S Gonçalves ◽  
Pedro Amador ◽  
Lígia Mendes ◽  
Filipe Seixo ◽  
José F Santos
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Mortality ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Clinical Registry ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Timi Risk Score

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.

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.

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.

scholarly journals Risk stratification in acute coronary syndromes—does the TIMI risk score work in unselected cases?

QJM ◽  
2006 ◽  
Vol 99 (2) ◽  
pp. 81-87 ◽  
Author(s):  
R.L. Soiza ◽  
S.J. Leslie ◽  
P. Williamson ◽  
S. Wai ◽  
K. Harrild ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes ◽  
Timi Risk Score

Abstract 5585: Understanding Physicians’ Risk Stratification of Acute Coronary Syndromes: Insights from the Canadian ACS II Registry

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Andrew T Yan ◽  
Raymond T Yan ◽  
Thao Huynh ◽  
Amparo Casanova ◽  
F. E Raimondo ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Risk Scores ◽  
Risk Category ◽  
Patient Risk ◽  
Treatment Risk ◽  
Coronary Syndromes

An important treatment-risk paradox exists in the management of acute coronary syndromes (ACS). However, the process of risk stratification by physicians and its relationship to patient management have not been well studied. Our objective was to examine patient risk assessment by physician in relation to treatment and objective risk score evaluation, and the underlying patient characteristics that physicians consider to indicate high risk. The prospective Canadian ACS II Registry recruited 1956 patients admitted for non-ST elevation ACS in 36 hospitals in Oct 2002-Dec 2003. Patient risk assessment by the treating physician and management were recorded on standardized case report forms. We calculated the TIMI, PURSUIT and GRACE risk scores for each patient. Of the 1956 ACS patients, 347 (17.8%) patients were classified as low risk, 822 (42%) as intermediate risk, and 787 (40.2%) as high risk by their treating physicians. Patients considered as high risk were more likely to receive aggressive medical therapies and to undergo coronary angiography and revascularization. However, there were only weak correlations (Kendall’s tau-b correlation coefficients ranging from 0.08 to 0.14) between risk assessment by physicians and all 3 validated risk scores. Advanced age was an independent negative predictor. Furthermore, there was no significant association between the high risk category and several established prognosticators, such as history of heart failure, hemodynamic variables, and creatinine. Contemporary risk stratification of ACS appears suboptimal and may perpetuate the treatment-risk paradox. Physicians may not recognize and incorporate the most powerful adverse prognosticators into overall patient risk assessment. Routine use of validated risk score may enhance risk stratification and facilitate more appropriate tailoring of intensive therapies towards high-risk patients.

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&lt;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

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