HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wiviott, S. D. Articles by Braunwald, E. Search for Related Content PubMed PubMed Citation Articles by Wiviott, S. D. Articles by Braunwald, E.

ACUTE MYOCARDIAL INFARCTION

Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and -4

A simple index that predicts mortality in ST-segment elevation myocardial infarction

Stephen D. Wiviott, MD^*,,*, David A. Morrow, MD, MPH^*,, Paul D. Frederick, MPH, MBA, Robert P. Giugliano, SM, MD^*,, C.Michael Gibson, MS, MD^*,, Carolyn H. McCabe, BS^*,, Christopher P. Cannon, MD^*,, Elliott M. Antman, MD^*, and Eugene Braunwald, MD^*,

^* TIMI Study Group
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
Ovation Research, Seattle, Washington, USA
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Manuscript received October 22, 2003; revised manuscript received May 12, 2004, accepted May 18, 2004.

^* Reprint requests and correspondence: Dr. Stephen D. Wiviott, TIMI Study Group, Brigham and Women's Hospital, Cardiovascular Division, 75 Francis Street, Boston, Massachusetts 02115 (Email: swiviott{at}partners.org).

OBJECTIVES: We sought to evaluate a simple risk index based on age and vital signs in a community sample of patients with ST-segment elevation myocardial infarction (STEMI).

BACKGROUND: A simple risk index based on age and vital signs (heart rate x [age/10]²/systolic blood pressure) developed from patients with STEMI accurately predicts mortality in clinical trials of fibrinolysis. The application of such a tool in an unselected population is necessary to evaluate its utility in clinical practice.

METHODS: To evaluate the Thrombolysis In Myocardial Infarction (TIMI) risk index for routine practice, we tested it in the National Registry of Myocardial Infarction (NRMI)-3 and -4. The risk index was evaluated as a continuous variable in patients with STEMI from NRMI and in subgroups based on age and reperfusion status.

RESULTS: A total of 153,486 patients with STEMI were eligible. As anticipated, STEMI patients in NRMI had a higher risk index profile, as compared with those in the clinical trial (median 26.9 vs. 20, p < 0.0001). Classification of NRMI patients with STEMI into risk groups revealed a significant graded relationship with mortality (0.9% to53.2%, p_trend < 0.0001, c statistic 0.79). The discriminatory capacity of the risk index was particularly strong in the 81,679 patients receiving reperfusion therapy (0.6% to60%, p_trend < 0.0001, c statistic 0.81). For the 71,807 patients not receiving reperfusion therapy, a strong graded relationship remained (1.9% to 52.2%, p_trend < 0.0001, c statistic 0.71). Among the elderly, although the distribution of scores was shifted toward higher risk, the performance remained (0% to 53.1%, p_trend< 0.0001, c statistic 0.71).

CONCLUSIONS: A simple risk index from baseline clinical variables routinely obtained at the first patient encounter predicted mortality in a large unselected heterogeneous group of patients with STEMI.

Abbreviations and Acronyms   CCP = Cardiovascular Cooperative Project   HR = heart rate   InTIME-II = Intravenous nPA for Treatment of Infarcting Myocardium Early trial   IQR = interquartile range   MI = myocardial infarction   NRMI = National Registry of Myocardial Infarction   PCI = percutaneous coronary intervention   RT = reperfusion therapy   SBP = systolic blood pressure   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

This article has been cited by other articles:

				L. Testa, W.J. van Gaal, G.G.L. Biondi-Zoccai, A. Abbate, P. Agostoni, R. Bhindi, and A.P. Banning Repeat thrombolysis or conservative therapy vs. rescue percutaneous coronary intervention for failed thrombolysis: systematic review and meta-analysis QJM, May 1, 2008; 101(5): 387 - 395. [Abstract] [Full Text] [PDF]

				S. A. Hayat and R. Senior Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Eur. Heart J., February 1, 2008; 29(3): 299 - 314. [Abstract] [Full Text] [PDF]

				J. Oldgren, L. Wallentin, R. Afzal, J.-P. Bassand, A. Budaj, S. Chrolavicius, K. A.A. Fox, C. B. Granger, S. R. Mehta, P. Pais, et al. Effects of fondaparinux in patients with ST-segment elevation acute myocardial infarction not receiving reperfusion treatment Eur. Heart J., February 1, 2008; 29(3): 315 - 323. [Abstract] [Full Text] [PDF]

				K. Fox, J. S. Borer, A. J. Camm, N. Danchin, R. Ferrari, J. L. Lopez Sendon, P. G. Steg, J.-C. Tardif, L. Tavazzi, M. Tendera, et al. Resting Heart Rate in Cardiovascular Disease J. Am. Coll. Cardiol., August 28, 2007; 50(9): 823 - 830. [Abstract] [Full Text] [PDF]

				P. Ortolani, A. Marzocchi, C. Marrozzini, T. Palmerini, F. Saia, C. Serantoni, M. Aquilina, S. Silenzi, F. Baldazzi, D. Grosseto, et al. Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction Eur. Heart J., July 1, 2006; 27(13): 1550 - 1557. [Abstract] [Full Text] [PDF]

				S. D. Wiviott, D. A. Morrow, P. D. Frederick, E. M. Antman, and E. Braunwald Application of the Thrombolysis In Myocardial Infarction Risk Index in Non-ST-Segment Elevation Myocardial Infarction: Evaluation of Patients in the National Registry of Myocardial Infarction J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1553 - 1558. [Abstract] [Full Text] [PDF]

				T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]

				M. B. Rothberg, C. Celestin, L. D. Fiore, E. Lawler, and J. R. Cook Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit Ann Intern Med, August 16, 2005; 143(4): 241 - 250. [Abstract] [Full Text] [PDF]