Bartholomew Beth A, Sheps David S, Monroe Stephen, McGorray Susan, Smith Karen, Pepine Carl J
William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Clin Cardiol. 2004 Feb;27(2):74-8. doi: 10.1002/clc.4960270206.
The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) for unstable angina/non-ST elevation myocardial infarction (MI) was developed in patients presenting with unstable angina accompanied by high-risk features or non-ST elevation MI to determine early risk stratification.
The validity in patients presenting for emergency care with symptoms suggestive of acute coronary syndrome (ACS) has not been well established, and the present study sought to do so by evaluating the TIMI-RS in a prospective fashion.
A prospective TIMI-RS using seven variables was calculated in 245 patients admitted to the hospital with symptoms suggestive of ACS: (1) age > 65, (2) three or more cardiac risk factors, (3) ST deviation, (4) aspirin use within 7 days, (5) two or more anginal events over 24 h, (6) history of coronary stenosis, and (7) elevated troponin. Patients were contacted at 30 days and data were collected concerning major adverse cardiac events.
In patients presenting with chest pain, a higher TIMI-RS was associated with an increase in major adverse cardiac events within 30 days. We found that the 30-day event rate was 0% for a score of 1, 20% for a score of 2, 24% for a score of 3, 42% for a score of 4, 52% for a score of 5, and 70% for a score of 6 or 7 (p < 0.0001).
The TIMI-RS successfully differentiates early risk for major adverse cardiac events in a general population presenting with symptoms suggestive of acute coronary syndrome. A simple bedside calculation of the TIMI-RS provides rapid risk stratification, allowing facilitation of therapeutic decision making in patients with symptoms suggestive of ACS.
心肌梗死溶栓风险评分（TIMI-RS）用于不稳定型心绞痛/非ST段抬高型心肌梗死（MI），是在伴有高危特征的不稳定型心绞痛患者或非ST段抬高型MI患者中制定的，用于确定早期风险分层。
对于有急性冠状动脉综合征（ACS）症状前来急诊的患者，其有效性尚未得到充分证实，本研究旨在通过前瞻性评估TIMI-RS来证实这一点。
对245例因ACS症状入院的患者计算了使用七个变量的前瞻性TIMI-RS：（1）年龄>65岁，（2）三个或更多心脏危险因素，（3）ST段偏移，（4）7天内使用阿司匹林，（5）24小时内两次或更多次心绞痛发作，（6）冠状动脉狭窄病史，（7）肌钙蛋白升高。在30天时联系患者并收集有关主要不良心脏事件的数据。
在胸痛患者中，较高的TIMI-RS与30天内主要不良心脏事件的增加相关。我们发现，评分为1时30天事件发生率为0%，评分为2时为20%，评分为3时为24%，评分为4时为42%，评分为5时为52%，评分为6或7时为70%（p<0.0001）。
TIMI-RS成功区分了有急性冠状动脉综合征症状的普通人群中主要不良心脏事件的早期风险。床边简单计算TIMI-RS可提供快速风险分层，有助于对有ACS症状的患者进行治疗决策。
