Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population
Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population
复制标题
DOI：
10.1197/j.aem.2005.06.031
复制
发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Hollander, JE
中科院分区：
文献类型：
--
作者：
Pollack, CV;Sites, FD;Hollander, JE
目的：出现胸痛或提示心肌缺血的相关症状、心电图上无ST段抬高（NSTE）的患者通常会给急诊室（艾德）带来诊断挑战。及时和准确的风险分层，以确定那些NSTE胸痛患者谁是最高风险的不良事件是必不可少的，但是，最佳的管理。虽然在急性冠脉综合征试验中已经验证并经常用于患者，但心肌梗死溶栓（TIMI）风险范围从未在全方位、非试验基础的艾德胸痛人群中检查其风险分层价值。在3例患者中进行了一项基于ED的前瞻性观察性队列研究分析，929例出现胸痛综合征的成人患者，心电图评估。这些患者在艾德就诊时进行TIMI风险评分。主要结果是死亡，急性心肌梗死（MI），并在30 days.Results：TIMI风险评分在艾德介绍成功的风险分层这一队列的胸痛患者30天的不良后果，范围从2.1%，得分或0，到100%，得分为7。与不良结局相关性最高的个体TIMI风险指标是入院时心脏生物标志物升高。总的来说，该评分有类似的性能特点，当应用于其他数据库的患者参加临床试验和注册使用14天的endpoint.Conclusions：TIMI风险评分可能是一个有用的工具，艾德患者胸痛综合征的风险分层。
Objectives: Patients presenting with chest pain or related symptoms suggestive of myocardial ischemia, without ST-segment elevation (NSTE) on their presenting electrocardiograms, often present a diagnostic challenge in the emergency department (ED). Prompt and accurate risk stratification to identify those patients with NSTE chest pain who are at highest risk for adverse events is essential, however, to optimal management. Although validated and used frequently in patients already enrolled in acute coronary syndrome trials, the Thrombolysis in Myocardial Infarction (TIMI) risk scope never has been examined for its value in risk stratification in an all-corners, non-trial-based ED chest pain population.Methods: An analysis of an ED-based prospective observational cohort study was conducted in 3,929 adult patients presenting with chest pain syndrome and warranting evaluation with an electrocardiogram. These patients had TIMI risk scores determined at ED presentation. The main outcome was the composite of death, acute myocardial infarction (MI), and revascularization within 30 days.Results: The TIMI risk score at ED presentation successfully risk-stratified this unselected cohort of chest pain patients with respect to 30-day adverse outcome, with a range from 2.1%, with a score or 0, to 100%, with a score of 7. The highest correlation or an individual TIMI risk indicator to adverse outcome was for elevated cardiac biomarker at admission. Overall, the score had similar performance characteristics to that seen when applied to other databases of patients enrolled in clinical trials and registries using a 14-day end point.Conclusions: The TIMI risk score may be a useful tool for risk stratification of ED patients with chest pain syndrome.