Sawalha Khalid, Khan Shoaib, Suarez Edwin, Beresic Nicholas, Kamoga Gilbert-Roy
Internal Medicine Department, White River Health System, Batesville, AR, USA.
Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA.
J Community Hosp Intern Med Perspect. 2021 Jun 21;11(4):446-449. doi: 10.1080/20009666.2021.1930506.
: The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. An estimated number 25,000 deaths than their urban counterparts, which coincide with a TIMI risk score of ≥3, potentially limit the utility of the TIMI risk score in risk stratification in rural catherization laboratories. The objective of this study was to assess the reliability of TIMI score as early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in rural hospital. : A retrospective chart review study in a rural hospital was conducted for subjects that received left heart catheterizations, exercise stress tests, or chemical stress tests for a diagnosis of UA/NSTEMI. A total of 399 subjects who underwent left heart catheterization and/or stress testing were recruited for this study. A total of 153 subjects who were transferred out to a larger facility, transitioned to comfort care, refused intervention, or passed away were excluded from the study. The 246 remaining subjects were classified into two groups, those with TIMI 0-2 compared with those having TIMI ≥ 3. A null hypothesis was postulated that there was no significant difference between the two groups with regard to prevalence of either positive stress test or evidence of obstructive coronary disease following coronary angiography. T-test and Wilcoxon rank-sum analysis were performed through SPSS statistical analysis. : Formal statistical analysis using T-test as well as Wilcoxon rank-sum test comparing the two groups showed = 0.34 for T-test and = 0.60 for Wilcoxon rank-sum test. This is consistent with the postulated null hypothesis: that there is no significant difference between the two surgery groups with respect to the mean/median TIMI score. : There was no statistical difference between high and low TIMI score in the intervention of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in a rural hospital.
心肌梗死溶栓（TIMI）评分被认为是不稳定型心绞痛/非ST段抬高型心肌梗死（UA/NSTEMI）患者早期风险分层的一种方法。它由七个因素组成，若存在，每个因素对TIMI风险评分贡献一分，使其成为一个简单的工具，无需对每个因素赋予不同权重。评分越高，发生不良心脏事件和/或死亡风险的可能性越高。TIMI风险评分≥3建议早期进行心脏血管造影和血运重建的侵入性治疗。根据美国疾病控制与预防中心2014年的研究，生活在农村地区的美国人死于心血管疾病等主要原因的可能性更高。估计比城市居民多25000人死亡，这与TIMI风险评分≥3相符，可能限制了TIMI风险评分在农村导管实验室风险分层中的效用。本研究的目的是评估TIMI评分作为农村医院不稳定型心绞痛/非ST段抬高型心肌梗死（UA/NSTEMI）患者早期风险分层的可靠性。
在一家农村医院进行了一项回顾性病历审查研究，对象为接受左心导管检查、运动负荷试验或化学负荷试验以诊断UA/NSTEMI的患者。本研究共招募了399名接受左心导管检查和/或负荷试验的受试者。共有153名被转至更大医疗机构、转为舒适护理、拒绝干预或去世的受试者被排除在研究之外。其余246名受试者分为两组，TIMI 0 - 2组与TIMI≥3组。提出一个零假设，即两组在负荷试验阳性率或冠状动脉造影后阻塞性冠状动脉疾病证据方面无显著差异。通过SPSS统计分析进行t检验和Wilcoxon秩和分析。
使用t检验以及Wilcoxon秩和检验对两组进行的正式统计分析显示，t检验的P值 = 0.34，Wilcoxon秩和检验的P值 = 0.60。这与假定的零假设一致：即两个手术组在平均/中位数TIMI评分方面无显著差异。
农村医院不稳定型心绞痛/非ST段抬高型心肌梗死（UA/NSTEMI）的干预中，高TIMI评分和低TIMI评分之间无统计学差异。
