TIMI risk score valid for emergency chest pain diagnosis
MedWire News: The Thrombolysis in Myocardial Infarction (TIMI) risk score is useful for risk-stratifying patients with suspected acute coronary syndromes (ACS) in the emergency department, US researchers say.
However, they warn that the TIMI score should not be relied upon as the sole means of determining patients’ prognosis in view of its suboptimal specificity.
The TIMI score uses clinical data to predict the short-term risk for acute myocardial infarction, coronary revascularization, and death from any cause. It was originally designed for use in patients with unstable angina or non-ST-elevation myocardial infarction but has been broadly validated in patients with acute chest pain.
In this study, Erik Hess (Mayo Clinic College of Medicine, Rochester, Minnesota) and team performed a systematic review and meta-analysis to assess the diagnostic and prognostic accuracy of the TIMI risk score in patients with chest pain in the emergency department.
The team identified 10 prospective cohort studies that validated the TIMI score in a total of 17,265 emergency department patients. Meta-regression analysis revealed a strong linear correlation between TIMI risk score and the cumulative incidence of cardiac events, they report in the Journal of the Canadian Medical Association.
The prevalence of cardiac events was 1.8% in patients with a TIMI risk score of 0 and 4.0% in those with a score of 1. A score of 0 predicted the prevalence of cardiac events with a sensitivity of 97.2%, a specificity of 25.0%, a positive likelihood ratio of 1.30, a and negative likelihood ratio of 0.11.
“Although the total number of patients in each risk stratum decreased progressively with each successive increase in TIMI risk score, the proportion with adverse outcomes increased up to a score of 5 or greater,” the authors remark.
They say their analysis “supports the consistent performance of the TIMI risk score” and estimate that for every 1000 patients in the lowest risk category, 20 will experience a cardiac event within 30 days.
“Although this rate may render the TIMI risk score an unacceptable single reason to dismiss patients from the emergency department, this rate highlights the potential utility of this score as an adjunct to clinical acumen, as a source of information for patient decision aids, and as a benchmark for researchers developing new prognostic and disposition tools,” the authors conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Joanna Lyford