Timi score for stemi3/7/2023 Performance of the multivariate analysis and derivation of the risk score were based on patients with complete baseline data (93.7%), with subsequent reevaluation in the full population. The prognostic performance of the Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI was then compared with that of other risk models and validated in an external data set composed of nearly 3700 patients with STEMI. Therefore, we developed a clinical risk score that can be calculated easily at the bedside but is derived from a comprehensive multivariable analysis in a well-characterized population of nearly 15 000 patients with STEMI from the Intravenous nPA for Treatment of Infarcting Myocardium Early II (InTIME II) trial. 6 Although such models offer important insight into the relationships between clinical data and prognosis, they are not readily applied in routine clinical practice. Sophisticated multivariable models developed for the prediction of mortality among patients with STEMI identify independent clinical predictors and quantify their relative contribution to mortality risk. A risk model satisfying these objectives could also be useful in adjusting for baseline risk in epidemiological studies, such as those examining variation in practice patterns, provider types, or specific therapies. However, to perform accurately, the tool should use data that offer independent prognostic information and must take into account the complex profile of patients with multiple risk factors. To be practical clinically, a risk stratification tool should be simple and easily applied at the bedside and should make use of clinical data that are routinely available at hospital presentation. Algorithms that aid clinicians in assessing prognosis may therefore be useful in guiding management and in providing valuable information for patients and their families. 1 2 Careful risk assessment for each patient informs decisions regarding therapeutic interventions, triage among alternative levels of hospital care, and allocation of clinical resources. This risk assessment tool is likely to be clinically useful in the triage and management of fibrinolytic-eligible patients with STEMI.Ĭonsiderable variability in short-term mortality risk exists among patients with ST-elevation myocardial infarction (STEMI) who receive fibrinolytic therapy. External validation in the TIMI 9 trial showed similar prognostic capacity (c statistic 0.746).Ĭonclusions-The TIMI risk score for STEMI captures the majority of prognostic information offered by a full logistic regression model but is more readily used at the bedside. The prognostic performance of the risk score was stable over multiple time points (1 to 365 days). The prognostic discriminatory capacity of the TIMI risk score was comparable to the full multivariable model (c statistic 0.779 versus 0.784). The risk score showed a >40-fold graded increase in mortality, with scores ranging from 0 to >8 ( P<0.0001) mortality was <1% among patients with a score of 0. Ten baseline variables, accounting for 97% of the predictive capacity of the multivariate model, constituted the TIMI risk score. The Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI was created as the simple arithmetic sum of independent predictors of mortality weighted according to the adjusted odds ratios from logistic regression analysis in the Intravenous nPA for Treatment of Infarcting Myocardium Early II trial (n=14 114). Methods and Results-We developed and evaluated a convenient bedside clinical risk score for predicting 30-day mortality at presentation of fibrinolytic-eligible patients with STEMI. Complex multivariable models identify independent predictors and quantify their relative contribution to mortality risk but are too cumbersome to be readily applied in clinical practice. Customer Service and Ordering Informationīackground-Considerable variability in mortality risk exists among patients with ST-elevation myocardial infarction (STEMI).Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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