The TIMI (Thrombolysis in Myocardial Infarction) risk score of Antman et al can be used to evaluate a patient with chest pain. Morris et al reported the TIMI score but without the serum biomarker as the Front Door TIMI (FDTIMI). This can be used to evaluate a patient prior to arrival at the hospital. The authors are from the Royal Infirmary Edinburgh.
Patient selection: chest pain
Outcomes: probability of 30-day major cardiac event (STEMI, troponin-positive ACS not diagnosed at presentation, angioplasty, all-cause mortality at 30 days, readmission at 30 days)
Parameters:
(1) age
(2) risk factors for coronary artery disease (family history of coronary artery disease, hypertension, hypercholesterolemia, diabetes mellitus, being a current smoker)
(3) significant coronary artery stenosis on angiography (history of coronary artery stenosis)
(4) ST deviation
(5) severe anginal symptoms (number of anginal events in past 24 hours)
(6) use of aspirin within past 7 days
|
Parameter
|
Finding
|
Points
|
|
age
|
< 65 years
|
0
|
|
|
>= 65 years
|
1
|
|
risk factors for coronary artery disease
|
<= 2 risk factors
|
0
|
|
|
>= 3 risk factors
|
1
|
|
significant coronary artery stenosis
|
< 50% stenosis
|
0
|
|
|
>= 50% stenosis
|
1
|
|
ST deviation
|
none
|
0
|
|
|
transient elevation
|
1
|
|
|
persistent elevation or depression >= 0.5 mm (>= 0.05 mV)
|
1
|
|
severe anginal symptoms
|
none or 1 episode in past 24 hours
|
0
|
|
|
2 or more episodes in past 24 hours
|
1
|
|
use of aspirin in last 7 days
|
no
|
0
|
|
|
yes
|
1
|
TIMI risk score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score, the greater the risk for the outcome.
|
FDTIMI
|
Probability of Outcomes
|
|
0
|
5%
|
|
1
|
8%
|
|
2
|
16%
|
|
3
|
21%
|
|
4
|
22%
|
|
5
|
41%
|
|
6
|
64%
|
Performance:
• The area under the ROC curve is 0.70 (vs 0.79 for the full TIMI).
