Sabatine Marc S, Antman Elliott M
TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2003 Feb 19;41(4 Suppl S):89S-95S. doi: 10.1016/s0735-1097(02)03019-x.
Risk stratification in unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) can provide an estimate of a patient's prognosis and optimize clinical choices. The Thrombolysis In Myocardial Infarction (TIMI) risk score for UA/NSTEMI is an integrated approach that uses baseline variables that are part of the routine medical evaluation to identify patients at high risk for death and other major cardiac ischemic events. Using multivariable logistic regression, seven independent predictor variables were identified: age > or = 65 years, > or = 3 risk factors for coronary artery disease (CAD), known CAD (stenosis > or = 50%), severe anginal symptoms (> or = 2 anginal events in preceding 24 h), use of aspirin in the last seven days, ST-segment deviation > or = 0.05 mV, and elevated serum cardiac markers of necrosis. Each predictor carried similar prognostic weight; therefore, a risk score was constructed as the simple arithmetic sum of the number of predictors. The rate of death, MI, or urgent revascularization significantly increased as the TIMI risk score increased, ranging from < 5% for patients with a risk score of 0 or 1 to > 40% for patients with a risk score of 6 or 7. The risk score has been validated in several other trials of UA/NSTEMI. In addition, using the risk score to categorize patients also effectively defines a gradient for benefit with specific treatments such as low-molecular-weight heparins, glycoprotein IIb/IIIa inhibitors, and an early invasive strategy.
不稳定型心绞痛（UA）/非ST段抬高型心肌梗死（NSTEMI）的风险分层可用于评估患者的预后并优化临床决策。心肌梗死溶栓治疗（TIMI）风险评分是一种综合方法，它利用常规医学评估中的基线变量来识别死亡及其他重大心脏缺血事件的高危患者。通过多变量逻辑回归分析，确定了七个独立预测变量：年龄≥65岁、≥3个冠状动脉疾病（CAD）危险因素、已知CAD（狭窄≥50%）、严重心绞痛症状（前24小时内≥2次心绞痛发作）、过去七天内使用过阿司匹林、ST段偏移≥0.05mV以及血清心肌坏死标志物升高。每个预测变量的预后权重相似；因此，将风险评分构建为预测变量数量的简单算术和。随着TIMI风险评分的增加，死亡、心肌梗死或紧急血运重建的发生率显著上升，风险评分为0或1的患者发生率<5%，而风险评分为6或7的患者发生率>40%。该风险评分已在其他多项UA/NSTEMI试验中得到验证。此外，使用风险评分对患者进行分类还能有效确定特定治疗（如低分子量肝素、糖蛋白IIb/IIIa抑制剂和早期侵入性策略）的获益梯度。
