The TIMI 11b and ESSENCE trials have shown that nearly one-third of myocardial infarctions and half the number of deaths occur after the first week of presentation. The timing at which certain complications enfold has been another factor of interest. There was no significant difference in outcome between low-risk patients who received early intervention and those who received medical management. After risk stratifying patients, they found that intermediate or high-risk patients who underwent invasive cardiac intervention showed a significant decrease in death, nonfatal MI, and rehospitalization for cardiac events compared to those who were medically managed.
TIMI SCORE FOR NON STEMI TRIAL
The TACTICS-TIMI 18 trial compared outcomes of patients presenting with UA/NSTEMI who underwent either early invasive interventions or conservative treatment with medication. Perhaps the greatest utility that the TIMI score has to offer is its ability to guide the management of patients presenting with signs of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). Nursing, Allied Health, and Interprofessional Team Interventions Recent studies have also shown that the amplitude of ST-segment elevation or depression and the degree of cardiac biomarker elevation (troponin T/I) can both be independent factors that could point toward initiating early invasive cardiac procedures.
Studies have also noted that of the seven factors that contribute to the TIMI risk score, history of coronary artery disease, age greater than or equal to 65, and deviations in ST-segment on initial EKG’s were more strongly associated with adverse cardiac events as compared to the other factors. The study found that patients who had a risk score of 5 to 7 were significantly more likely to have severe culprit stenosis, multivessel disease, left main coronary artery disease, or visible thrombus compared to those who were in the low-risk score category. The TIMI risk score was found to be predictive of the severity of the vascular disease, making it a powerful tool to predict the potential blood vessels of coronary circulation that could be involved.Ī sub-study of PRISM-PLUS compared TIMI risk scores to findings on coronary angiography. However, other studies have shown that the TIMI, CADILLAC, and PAMI scores were superior to the GRACE score in determining high-risk patients in need of cardiac catheterization. Studies have shown that the CADILLAC score was more helpful in predicting six-month to one-year outcomes. Issues of ConcernĪpart from the TIMI risk score, there are other predictive tools such as the GRACE, PAMI, and CADILLAC risk scores that provide insight into management and mortality risk assessment. Studies have shown that the TIMI risk score is far superior in providing diagnostic evidence for acute coronary syndrome (ACS) compared to history, physical examination, EKG’s, or biomolecular cardiac markers alone. Scores from 3-5 are considered intermediate risk. Scores ranging from 0-2 constitute a low risk. The following represents scores paired with the percent risk of mortality, new/recurrent MI, or severe ischemia requiring further invasive cardiac intervention. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. If present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. Elevated serum cardiac markers of necrosis.ST-segment deviations greater than or equal to 0.05 mV on initial ECG at admission.Presence of greater than or equal to 2 episodes of angina 24 hours before the presentation.Previous history of coronary stenosis of 50% or more.Presence of at least three risk factors for coronary artery disease (i.e., diabetes mellitus, hypertension, hyperlipidemia, smoking, family history).According to several trials, notably TIMI 11B and ESSENCE, seven factors help assess the mortality risk and risk of other adverse cardiac events, as listed below. The thrombolysis in myocardial infarction (TIMI) score is considered a tool for early risk stratification. Additionally, it helps predict the likelihood of adverse cardiac events. Primarily, it helps in making decisions about patient management.
The need for this stratification is two-fold. Patients who initially present with signs and symptoms of unstable angina or non-ST elevated myocardial infarction require risk stratification.
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