#TIMI SCORE AND AMERICAN TRIAL#

10 It is unclear whether prognostic data derived from InTIME II, a cohort in which all patients underwent fibrinolytic therapy, are applicable to elderly patients who did not receive any reperfusion therapy. 9 Of particular concern are the > 60% of community-based elderly patients with STEMI who do not receive fibrinolytic therapy. 8 Community-based elderly patients are generally older, have a substantially higher comorbidity burden, and are treated at a more diverse spectrum of hospitals, with a variety of treatment strategies, compared with patients enrolled in RCTs.

#TIMI SCORE AND AMERICAN TRIAL#

Although the TIMI score performed well in the randomized controlled trial (RCT) population in which it was developed and the TIMI 9A/B clinical trial cohort in which it was validated, 6 it is unclear how accurate the TIMI score is when applied to elderly patients, a group that is not well represented in RCT populations. Generalizability and validity are the sine qua non of prognostic models. 6 Developed as part of the InTIME II trial, 7 the TIMI score is a simple integer score that stratifies patients’ prognosis and provides specific short-term mortality estimates. 4, 5 One of the best known risk scores for patients hospitalized with ST-elevation myocardial infarction (STEMI) is the TIMI ST-elevation risk score (hereafter referred to as the TIMI score). 1 Effective management of these patients requires an accurate estimation of their prognosis, and current risk-assessment tools span the spectrum from simple risk scores 2, 3 to complex multivariable models. Tools such as this can assist clinicans as they make decisions about which populations will benefit most from acute coronary interventions, more advanced antitrombin therapies or the use of newer antiplatelet agents.Elderly patients constitute the majority of patients hospitalized with acute coronary syndromes. This study provides a practical and fairly easy to use method by which practitioners can risk stratify patients presenting with acute coronary syndromes. The greatest benefit of low molecular weight heparin compared to unfractionated heparin occurred in patients with multiple risk variables, particularly those with four or more of the seven high-risk markers. unfractionated heparin in patients at various risk levels. The analysis also compared the relative benefit of low molecular weight heparin (enoxaparin) vs. The rate of the composite endpoint varied from as low as 4.7% in patients with no or one marker to a level of 40.9% in those with six or seven of the markers noted. Patients with no or one variable had a mortality rate of 1.2%, those with four variables had 2.5% and those with six or seven markers had a mortality rate of 6.5%. By aggregating patients with 0 to as many as 7 markers, a corresponding stepwise increase in the overall risk of mortality, myocardial infarction and urgent revascularization was observed. The seven independent predictor variables of the combined endpoints included age > 65 years, three or more risk factors for coronary heart disease, known prior coronary stenosis of at least 50%, ST-segment elevation or depression on presenting electrocardiography, two or more anginal episodes in the preceding 24 hours, aspirin use within a week of presentation and elevated serum markers of myocardial injury.

Timi score and american