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Risk Score of Wylie et al for Congestive Heart Failure in a Patient with Unstable Angina or non-ST Elevation Myocardial Infarction from TIMI Trials

Purpose: To evaluate a patient with unstable angina or non-ST segment elevation AMI for risk of CHF using the risk score of Wylie et al from the TIMI Study Group.

Description

Wylie et al reported a score for predicting risk of developing congestive heart failure (CHF) in a patient with unstable angina or non-ST-segment elevation myocardial infarction (acute coronary syndrome). This can help identify patients who need to be monitored more closely and who may benefit from more aggressive management. The authors are from the TIMI Study Group.


Parameters:

(1) age in years

(2) heart rate

(3) history of diabetes mellitus

(4) angiographically proven evidence of coronary artery disease (CAD) with > 50% stenosis

(5) lateral ECG changes

(6) BNP level in pg/mL

 

Lateral ECG changes include one or both of the following:

(1) ST depression >= 0.5 mm in leads I, aVL, V5 or V6

(2) T wave inversion >= 3.0 mm in leads I, aVL, V5 or V6

 

Parameter

Findings

Points

age in years

<= 65 years of age

0

 

> 65 years of age

1

heart rate

<= 100 beats per minute

0

 

> 100 beats per minute

1

history of diabetes mellitus

absent

0

 

present

1

angiographically proven CAD

absent

0

 

present

1

lateral ECG changes

absent

0

 

present

1

BNP level in pg/mL

< 80 pg/mL

0

 

>= 80 pg/mL

1

 

number of risk factors present =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 6

• The greater the number of risk factors the greater the risk of developing heart failure at 30 days and 10 months.

 

Risk Score

Risk of CHF

CHF Risk at 10 Months (TIMI 16)

0 or 1

very low

1-3%

2 or 3

low

6 - 10%

4, 5 or 6

moderate

16%

 


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Specialty

Objective

ICD-10