Amin et al modified the TIMI risk score of Morrow et al for risk assessment at presentation for a patient with ST-elevation myocardial infarction (STEMI). The dynamic risk score provided better risk discrimination than the original risk score by identifying complications. The authors are from the University of California at Los Angeles, Brigham and Women’s Hospital and Tufts University.
Patient selection: STEMI
Outcome: 1-year mortality rate
Parameters shared with the TIMI risk score of Morrow et al:
(1) age in years
(2) systolic blood pressure in mm Hg
(3) heart rate in beats per minute
(4) Killip class
(5) anterior infarct (ST elevation) or left bundle branch block (LBBB)
(6) risk factors (diabetes, hypertension, history of angina)
(7) body weight in kilograms
(8) time to treatment in hours
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
2 |
|
|
>= 75 years |
3 |
|
systolic blood pressure |
>= 100 mm Hg |
0 |
|
|
< 100 mm Hg |
3 |
|
heart rate |
<= 100 beats per minute |
0 |
|
|
> 100 beats per minute |
2 |
|
Killip class |
I |
0 |
|
|
II, III or IV |
2 |
|
anterior infarct or LBBB |
absent |
0 |
|
|
present |
1 |
|
risk factors |
none |
0 |
|
|
one or more of diabetes, hypertension or history of angina |
1 |
|
body weight |
>= 67 kig |
0 |
|
|
< 67 kg |
1 |
|
time to treatment |
<= 4 hours |
0 |
|
|
> 4 hours |
1 |
Additional parameters include:
(9) recurrent myocardial infarction
(10) stroke
(11) major bleed
(12) CHF with shock
(13) cardiac arrhythmia
(14) renal failure
|
Parameter |
Finding |
Points |
|
recurrent myocardial infarction |
absent |
0 |
|
|
present |
1 |
|
stroke |
absent |
0 |
|
|
present |
5 |
|
major bleed |
absent |
0 |
|
|
present |
1 |
|
CHF with shock |
absent |
0 |
|
|
present |
3 |
|
cardiac arrhythmia |
absent |
0 |
|
|
present |
2 |
|
renal failure |
absent |
0 |
|
|
present |
3 |
total score =
= SUM(points for all 14 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 29 (14 for original items and 15 for additional)
• The higher the score the greater the 1-year mortality rate.
|
Score |
1-Year Mortality |
Risk Group |
|
0 to 3 |
< 5% |
low |
|
4 to 7 |
5 to 15% |
moderate |
|
8 to 29 |
> 15% |
high |
|
Score |
1-Year Mortality |
|
0 or 1 |
1.3% |
|
2 |
2.3% |
|
3 |
3.6% |
|
4 |
5.5% |
|
5 |
8% |
|
6 or 7 |
14% |
|
8 to 29 |
25% |
from Figure 1, based on EXTRACT-TIMI 25
Performance:
• The area under the ROC curve was 0.76.
Purpose: To evaluate a patient with ST-elevation myocardial infarction (STEMI) using the risk score of Amin et al.
Specialty: Cardiology
Objective: risk factors, severity, prognosis, stage
ICD-10: I21, I22,
