Comparison of MACE between High and Low TIMI Risk
Abstract
Introduction: Patients with ST-segment elevation myocardial infarction (STEMI) have increased risk for death and adverse cardiac events. Of great concern is the risk of cardiac arrest that accounts for the majority of early deaths and other major adverse cardiac events. Significant hospital resources are dedicated to these high risk patients.
Objective: To see the correlation of MACE between High and Low TIMI Risk.
Methodology: This cross-sectional prospective study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from July 2017 to June 2018. Fifty patients with definite diagnosis of acute STEMI, received streptokinase, aged above 18 years and both sex were included. Prior myocardial infarction, coronary revascularization procedures either CABG or angioplasty or coronary stenting; co-morbidities such as renal failure, heart failure, cardiomyopathy, valvular heart disease and congenital heart disease were excluded. On admission TIMI was recorded. In hospital MACE were also recorded.
Results: The mean age of patients was 52.64 (SD 11.88) years and majority of the patients were male (84%) with male to female ratio was 5.25:1. The mean TIMI risk score for STEMI 4.50 (SD 2.38). In hospital major adverse cardiac events (MACE) occurred in 19 (38.0%) cases. TIMI risk score for STEMI was significantly higher in patients with MACE compared to without MACE (16.95, SD 1.78 versus 3.00, SD 1.10; p<0.001) respectively.
Conclusion: In hospital major adverse cardiac events (MACE) occurred in 19 (38.0%) cases. TIMI risk score for STEMI was significantly higher in patients with MACE compared to patients without MACE (16.95, SD 1.78 versus 3.00, SD 1.10; p<0.001) respectively. From the study we conclude that TIMI risk score (5 or above) is a reliable tool in predicting in- hospital major adverse cardiac events in ST-segment elevation myocardial infarction.
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References
Canty JM, 2008. Coronary blood flow and myocardial ischaemia. In: Libby P, Bonow RO, Mann DL, Zipes DP, Eds. Braunwald’s Heart Disease. 8th ed. WB Saunders: Philadelphia, pp. 1167-1194.
Newby LK, Calief MR, Guerci A. Weaver WD, Col J, Horgan JH, et al. 1996. Early discharge in the thrombolytic era: an analysis of criteria for uncomplicated infarction from the global infarction from the global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO) trial. J Am Coll card, 27, 625-632.
Morrow DA, Antman EM, Giugliano RP, Cairns R, Charlesworth A, Murphy SA, et al. 2001. A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: an InTIME II substudy. Lancet, 358(9293), 1571-1575.
Ehsan MA, Mahmood M, Siddique MA, Banerjee SK, Khan LF, Hasan ATMI, et al. 2012. Prediction of Major Adverse Cardiac Events of Patients with Acute Coronary Syndrome by Using TIMI Risk Score. University Heart Journal, 8(2), 73-79.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. 2012. Third universal definition of myocardial infarction. European Heart Journal, 33(20), 2551–2567.
Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Apple FS, Galvani M, et al; Joint ESC/ACCF/AHA/ WHF Task Force for the Redefinition of Myocardial Infarction. 2007. Universal definition of myocardial infarction. Circulation, 116, 2634–2653.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al; for American Heart Association Statistics Committee.; Stroke Statistics Subcommittee. 2016. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation, 133, e38-e60.
McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. 2010. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med, 124(1), 40–47.
Sugiyama T, Hasegawa K, Kobayashi Y, Takahashi O, Fukui T, Tsugawa Y. 2015. Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001-2011. J Am Heart Assoc, 4(3), e001445.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al; ESC Scientific Document Group. 2018. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 39(2), 119-177.
Zaman MM, Ahmed J, Choudhury SR, Parvin K, Islam MS. 2007. Prevalence of Ischemic Heart Disease in a Rural Population of Bangladesh. Indian Heart Journal, 59, 316-322.
Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, et al. 2000. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy. Circulation, 102, 2031–2037.
Singh SP, Rajender M. 2015. A prospective observational study on risk assessment of stemi patients at a tertiary care hospital. Int J Pharm Pharm Sci, 7(2), 148-153.
Masood A, Naqvi MA, Jafar SS, Mufti AA, Akram Z. 2009. In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score. J Ayub Med Coll Abbottabad, 21(4), 24-27.
Alam MS, Ullah M, Ulabbi SU, Haque MM, Uddin R, Mamun MS, et al. 2011. Prediction of the Site of Coronary Artery Lesion in Acute Inferior Myocardial Infarction with Right Sided Precordial Lead (V4r). Cardiovasc J, 4, 46-52.
Chen Y-H, Huang S-S, Lin S-J. 2018. TIMI and GRACE Risk Scores Predict Both Short-Term and Long-Term Outcomes in Chinese Patients with Acute Myocardial Infarction. Acta Cardiol Sin, 34, 4-12.
Correia LCL, Garcia G, Kalil F, Ferreira F, Carvalhal M, Oliveira R, et al. 2014. Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction. Arq Bras Cardiol, 103(2), 98-106.
Silveira DS, Jaeger CP, Hatschbach L, Manenti ERF. 2016. Validation of TIMI risk score for STEMI. International Journal of Cardiovascular Sciences, 29(3), 189-197.
Betancourt-Plaza I, Martos-Benítez FD. 2016. TIMI score as a predictor of death in patients with acute myocardial infarction without percutaneous coronary intervention CorSalud, 8(2), 111-116.
González-Pacheco H, Arias-Mendoza A, Álvarez-Sangabriel A, Juárez-Herrera U, Damas F, Eid-Lidt G, et al. 2012. The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty. Arch Cardiol Mex, 82(1), 7-13.
