McGill Health University Centre, McGill University, Montreal, Canada.
Can J Cardiol. 2009 Dec;25(12):e417-21. doi: 10.1016/s0828-282x(09)70536-7.
Although the Thrombolysis In Myocardial Infarction (TIMI) score incorporates ST deviation, it does not account for characteristics of the ST deviations. In the present study, it was hypothesized that the magnitude and characteristics of ST deviation may add to the prognostic values of the TIMI risk score in acute coronary syndrome (ACS) patients, particularly in lower-risk patients with a TIMI risk score of less than 5.
To evaluate the prognostic value of combining the TIMI risk score and characteristics of ST deviation in patients with non-ST elevation ACS and a TIMI risk score of less than 5.
The death/myocardial infarction (MI) rates of 1296 patients enrolled in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) angiographic substudy were examined.
Patients without a TIMI risk score of 5 or greater, and without an ST deviation of 1 mm or greater had the lowest six-month rate of death/ MI (5%). In patients with a TIMI risk score of less than 5, the six-month death/MI rate was increased in those with ST depression of 2 mm or greater compared with patients with a similar TIMI risk score and without ST deviation of 1 mm or greater (24% versus 5%, P<0.001). The presence of ST deviation of 2 mm or greater identified an additional 15% of patients with an increased six-month death/MI rate in patients with a TIMI risk score of less than 5.
ST segment deviation of 2 mm or greater confers additional prognostic information in non-ST elevation ACS patients with a TIMI risk score of less than 5. Patients with a TIMI risk score of less than 5 and ST deviation of 2 mm or less had the lowest risk of six-month death/MI.
虽然血栓溶栓治疗心肌梗死（TIMI）评分纳入 ST 段偏移，但它并未考虑 ST 段偏移的特征。在本研究中，假设 ST 段偏移的幅度和特征可能会增加 TIMI 风险评分在急性冠脉综合征（ACS）患者中的预后价值，特别是在 TIMI 风险评分低于 5 的低危患者中。
评估 TIMI 风险评分与非 ST 段抬高 ACS 且 TIMI 风险评分小于 5 的患者 ST 段偏移特征相结合的预后价值。
对血小板受体抑制缺血综合征管理患者中不稳定症状和体征（PRISM-PLUS）血管造影亚研究中纳入的 1296 例患者的死亡/心肌梗死（MI）发生率进行了检查。
没有 TIMI 风险评分大于等于 5，且没有 ST 段偏移大于等于 1mm 的患者，其 6 个月的死亡/MI 发生率最低（5%）。在 TIMI 风险评分小于 5 的患者中，与具有相似 TIMI 风险评分且无 1mm 或更大 ST 段偏移的患者相比，ST 段压低 2mm 或更大的患者 6 个月死亡/ MI 率升高（24%比 5%，P<0.001）。在 TIMI 风险评分小于 5 的患者中，存在 ST 段偏移 2mm 或更大的患者，其 6 个月死亡/ MI 率增加了 15%。
ST 段偏移 2mm 或更大在 TIMI 风险评分小于 5 的非 ST 段抬高 ACS 患者中提供了额外的预后信息。TIMI 风险评分小于 5 且 ST 段偏移小于 2mm 的患者，6 个月死亡/ MI 的风险最低。
