CLINICAL RESEARCH
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
Stephen D. Wiviott, MD*, ,*,
David A. Morrow, MD, MPH, FACC*,,
Paul D. Frederick, MPH, MBA ,
Elliott M. Antman, MD, FACC*, and
Eugene Braunwald, MD, MACC*,
* TIMI Study Group
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
Ovation Research Group, Seattle, Washington
Manuscript received September 23, 2005;
revised manuscript received November 11, 2005,
accepted November 20, 2005.
* Reprint requests and correspondence: Dr. Stephen D. Wiviott, TIMI Study Group, BWH, Cardiovascular Division, 75 Francis Street, Boston, Massachusetts 02115 (Email: swiviott{at}partners.org).
OBJECTIVES: The purpose of this research was to evaluate the Thrombolysis In Myocardial Infarction risk index (TRI) to characterize the risk of death among patients with non–ST-segment elevation myocardial infarction (NSTEMI).
BACKGROUND: The TRI, calculated from baseline age, systolic pressure, and heart rate, was established in patients with ST-segment elevation myocardial infarction (STEMI) and is predictive of mortality. Patients presenting with NSTEMI are increasing compared to STEMI and constitute a group with varied risk.
METHODS: The TRI was calculated in 337,192 patients from the National Registry of Myocardial Infarction with NSTEMI. Values and outcomes were compared with 153,486 patients with STEMI classified by reperfusion status. Comparisons of baseline characteristics and clinical outcomes stratified by TRI were made.
RESULTS: There was a graded relationship between the TRI and mortality in patients with NSTEMI with a >30-fold difference in mortality rates between lowest and highest deciles (p < 0.0001). The index showed good discrimination (c = 0.73). Overall mortality in the group with NSTEMI was higher (10.9%) than patients with STEMI treated with (6.6%) but lower than for STEMI patients not receiving reperfusion therapy (18.7%). The higher risk in comparison to patients with STEMI treated with reperfusion therapy was explained largely by the higher-risk profile of the population with NSTEMI.
CONCLUSIONS: There is a graded relationship between TRI and mortality in patients with NSTEMI. This simple risk index provides important information about mortality in patients across the spectrum of myocardial infarction, STEMI and NSTEMI. Early identification of NSTEMI patients who are at high risk of in-hospital mortality may provide clinicians with important information for initial triage and treatment.
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Abbreviations and Acronyms
| | CHF = congestive heart failure | | IQR = interquartile range | | LBBB = left bundle branch block | | LV = left ventricle/ventricular | | MI = myocardial infarction | | NRMI = National Registry of Myocardial Infarction | | NSTEMI = non–ST-segment elevation myocardial infarction | | STEMI = ST-segment elevation myocardial infarction | | TIMI = Thrombolysis In Myocardial Infarction | | TRI = Thrombolysis In Myocardial Infarction risk index |
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