Kumar Dileep, Saghir Tahir, Zahid Maham, Ashok Arti, Kumar Mukesh, Ali Shah Arshad, Shahid Izza, Ali Sajjad, Haque Ayema, Karim Musa
Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.
Department of Medicine, Ziauddin University, Karachi, PAK.
Cureus. 2021 Jan 6;13(1):e12518. doi: 10.7759/cureus.12518.
Background Accurate management of non-ST elevation myocardial infarction (NSTEMI) patients can be achieved by stratifying risks as early as possible on hospital admission. Previously, the Thrombolysis in Myocardial Infarction (TIMI) risk score has been validated and used on patients presenting with NSTEMI or unstable angina (UA) in developed countries. The aim of this study was to assess the validity of the TIMI risk score in patients presenting with NSTEMI in Pakistan. Methods This cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. The receiver operating characteristic (ROC) curve analysis was performed, and area under the curve (AUC) along with 95% confidence interval (CI) was reported. Univariate and multivariate logistic regression analysis was performed and odds ratio (OR) along with 95% CI was reported. Results This cross-sectional study was undertaken on 300 patients who were diagnosed with NSTEMI. Data were collected from medical records, the TIMI score was calculated, and 14-day outcome was recorded. Validity of TIMI score in predicting hospital mortality 14 days after the diagnosis of NSTEMI in a population in Pakistan was assessed by ROC curve and logistic regression analysis. The AUC of the TIMI score for predicting 14-day outcome was 0.788 [95% CI: 0.689-0.887], with optimal cutoff of ≥4 with sensitivity of 77.78%. On multivariate analysis, cardiac arrest at presentation and the TIMI risk score were found to be independent predictors of 14-day mortality with adjusted ORs of 136.49 [10.23-1821.27] and 2.67 [1.09-6.57], respectively. Conclusions The TIMI risk score is a useful and simple score for the stratification of patients with high risk of 14-day mortality with reasonably acceptable discriminating ability in patients with NSTEMI acute coronary syndrome.
背景 非ST段抬高型心肌梗死（NSTEMI）患者的准确管理可通过在入院时尽早进行风险分层来实现。此前，心肌梗死溶栓（TIMI）风险评分已在发达国家对NSTEMI或不稳定型心绞痛（UA）患者中得到验证并应用。本研究的目的是评估TIMI风险评分在巴基斯坦NSTEMI患者中的有效性。方法 本横断面研究纳入了300例被诊断为NSTEMI的患者。从病历中收集数据，计算TIMI评分，并记录14天的结局。进行了受试者操作特征（ROC）曲线分析，并报告了曲线下面积（AUC）以及95%置信区间（CI）。进行了单因素和多因素逻辑回归分析，并报告了比值比（OR）以及95%CI。结果 本横断面研究纳入了300例被诊断为NSTEMI的患者。从病历中收集数据，计算TIMI评分，并记录14天的结局。通过ROC曲线和逻辑回归分析评估了TIMI评分在预测巴基斯坦人群中NSTEMI诊断后14天医院死亡率方面的有效性。TIMI评分预测14天结局的AUC为0.788 [95%CI：0.689 - 0.887]，最佳截断值≥4，敏感性为77.78%。多因素分析显示，就诊时心脏骤停和TIMI风险评分是14天死亡率的独立预测因素，调整后的OR分别为136.49 [10.23 - 1821.27]和2.67 [1.09 - 6.57]。结论 TIMI风险评分是一种有用且简单的评分，可用于对14天死亡率高风险患者进行分层，在NSTEMI急性冠状动脉综合征患者中具有合理可接受的鉴别能力。
