Prospective validation of the thrombolysis in myocardial infarction risk score in the emergency department chest pain population
Prospective validation of the thrombolysis in myocardial infarction risk score in the emergency department chest pain population
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DOI：
10.1016/j.annemergmed.2006.01.032
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发表时间：
2006-09-01
影响因子：
6.2
通讯作者：
Hollander, Judd E.
中科院分区：
文献类型：
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作者：
Chase, Maureen;Robey, Jennifer L.;Hollander, Judd E.
研究目的：心肌梗死溶栓（TIMI）风险评分是一种7项工具，来源于不稳定型心绞痛/非ST段抬高型心肌梗死患者试验，用于结局方面的风险分层。在急诊科（艾德）潜在急性冠状动脉综合征患者中进行了回顾性评价，但尚未在该患者人群中进行前瞻性验证。为了验证使用TIMI风险评分在艾德，我们前瞻性地评估其潜在的效用在广泛的艾德胸痛patient population.Methods：这是一个前瞻性的观察性队列研究的连续艾德胸痛患者从2003年7月至2004年10月入组。数据包括人口统计学、病史和心脏病史以及TIMI风险评分的组成部分。研究者每天随访住院患者的住院过程，并对住院和出院患者进行30天随访。主要结果是死亡，急性心肌梗死，或血管重建分层的TIMI风险评分在30 days.Results：有1,481名合格的患者访问，30天随访完成1,458（98.4%）例。患者的平均年龄为53.2 ± 14岁，40%为男性，66%为黑人，30%为白色。95例患者发生心肌梗死。各TIMI风险因素的发生率为年龄大于65岁21%，已知冠状动脉狭窄18%，3个或更多风险因素26%，ST段偏移6%，过去24小时内2个或更多心绞痛事件33%，过去7天内使用阿司匹林35%，标记物升高6%。根据TIMI评分，30天死亡、急性心肌梗死和血运重建的发生率如下：TIMI 0，1.7%（95%置信区间[CI] 0.42 - 2.95）; TIMI 1，8.2%（95% CI 5.27 - 11.04）; TIMI 2，8.6%（95% CI 5.02 - 12.08）; TIMI 3，16.8%（95% CI 10.91 - 22.62）; TIMI 4，24.6%（95% CI 16.38 - 32.77）; TIMI 5，37.5%（95% CI 21.25 - 53.75）;和TIMI 6，33.3%（95% CI 0 - 100）。结论：在艾德胸痛患者中，TIMI风险评分确实与预后相关。然而，在我们的研究中，TIMI风险评分未能根据风险评分将这些患者分为离散组。此外，TIMI评分为0的风险最低的患者的不良事件发生率为1.7%。因此，TIMI风险评分不应单独用于确定艾德胸痛患者的处置。
Study objective: The Thrombolysis in Myocardial Infarction (TIMI) risk score is a 7-item tool derived from trials of patients with unstable angina/non-ST segment elevation myocardial infarction for risk stratification with respect to outcomes. It has been retrospectively evaluated in emergency department (ED) patients with potential acute coronary syndrome but has not been prospectively validated in this patient population. To validate the use of the TIMI risk score in the ED, we prospectively assess its potential utility in a broad ED chest pain patient population.Methods: This was a prospective observational cohort study of consecutive ED chest pain patients enrolled from July 2003 until October 2004. Data included demographics, medical and cardiac history, and components of the TIMI risk score. Investigators followed the hospital course daily for admitted patients, and 30-day follow-up was performed on hospitalized and discharged patients. The main outcome was death, acute myocardial infarction, or revascularization as stratified by TIMI risk score at 30 days.Results: There were 1,481 eligible patient visits; 30-day follow-up was completed on 1,458 (98.4%) patients. Patients had mean age of 53.2+/-14 years and were 40% men, 66% black, and 30% white. Myocardial infarction occurred in 95 patients. The incidence of each TIMI risk factor was age greater than 65 years 21%, known coronary stenosis 18%, 3 or more risk factors 26%, ST-segment deviation 6%, 2 or more anginal events in the previous 24 hours 33%, aspirin use in the previous 7 days 35%, and elevated markers 6%. The incidence of 30-day death, acute myocardial infarction, and revascularization according to TIMI score is as follows: TIMI 0, 1.7% (95% confidence interval [CI] 0.42 to 2.95); TIMI 1, 8.2% (95% Cl 5.27 to 11.04); TIMI 2, 8.6% (95% Cl 5.02 to 12.08); TIMI 3, 16.8% (95% Cl 10.91 to 22.62); TIMI 4, 24.6% (95% Cl 16.38 to 32.77); TIMI 5, 37.5% (95% CI 21.25 to 53.75); and TIMI 6, 33.3% (95% Cl 0 to 100). This relationship was highly significant.Conclusion: Among ED patients with chest pain, the TIMI risk score does correlate with outcome. However, in our study the TIMI risk score failed to stratify these patients into discrete groups according to risk score. Also, patients with the lowest risk as defined by a TIMI score of zero had a 1.7% incidence of adverse events. Therefore, the TIMI risk score should not be used in isolation to determine disposition of ED chest pain patients.