Modification of the Thrombolysis in Myocardial Infarction risk score for patients presenting with chest pain to the emergency department

被引:9
作者
Greenslade, Jaimi H. [1 ,2 ]
Chung, Kimberly [1 ]
Parsonage, William A. [3 ,4 ]
Hawkins, Tracey [1 ]
Than, Martin [5 ]
Pickering, John W. [6 ]
Cullen, Louise [1 ,3 ]
机构
[1] Royal Brisbane & Womens Hosp, Dept Emergency Med, Butterfield St, Brisbane, Qld 4029, Australia
[2] Univ Queensland, Fac Med, Brisbane, Qld, Australia
[3] Royal Brisbane & Womens Hosp, Dept Cardiol, Brisbane, Qld, Australia
[4] Queensland Univ Technol, Fac Hlth, Brisbane, Qld, Australia
[5] Christchurch Hosp, Emergency Med, Christchurch, New Zealand
[6] Univ Otago, Dept Med, Christchurch, New Zealand
关键词
acute coronary syndrome; chest pain; risk assessment; ACUTE CORONARY SYNDROME; SENSITIVITY TROPONIN-I; TIMI; RULE; STRATIFICATION; POPULATION; VALIDATION; PARAMETERS; OUTCOMES; TRIAL;
D O I
10.1111/1742-6723.12913
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To develop a modified Thrombolysis in Myocardial Infarction (TIMI) score to effectively risk stratify patients presenting to the ED with chest pain. Methods: A prospective observational study was conducted at two metropolitan EDs. Data were obtained during patient interview. The primary outcome was major adverse cardiovascular events (MACE) within 30 days of presentation. Two separate modifications of the TIMI score were developed. These scores were compared to the original TIMI in terms of the area under the receiver operating characteristic curve and diagnostic accuracy statistics (sensitivity, specificity, positive and negative predictive values). Results: Of 1760 patients, 364 (20.7%) experienced 30 day MACE. The first modified TIMI score was a simplified TIMI (s-TIMI) including four variables: age >= 65 years, three or more risk factors, high-sensitivity troponin (hs-cTnI) and electrocardiogram changes. The second score included the same four variables plus two Global Registry of Acute Coronary Events (GRACE) variables (systolic blood pressure and estimated glomerular filtration rate). This score was termed the GRACE TIMI (gTIMI). s-TIMI had a lower sensitivity compared to the original TIMI score (93.41 and 96.98%), but higher specificity (45.49 and 24.50%). The gTIMI had a sensitivity of 98.90% and specificity of 14.90%. Conclusions: Attempts to modify the TIMI score yielded two scores with added predictive utility in comparison to the original TIMI model. The addition of GRACE variables (g-TIMI) increased sensitivity for MACE, but decreased the specificity of the model. The s-TIMI score yielded good specificity but had sensitivity that would not be acceptable by emergency physicians. The s-TIMI may be useful as part of an accelerated chest pain protocol.
引用
收藏
页码:47 / 54
页数:8
相关论文
共 50 条
[41]   Modified TIMI risk score cannot be used to identify low-risk chest pain in the emergency department: a multicentre validation study [J].
Macdonald, Stephen P. J. ;
Nagree, Yusuf ;
Fatovich, Daniel M. ;
Brown, Simon G. A. .
EMERGENCY MEDICINE JOURNAL, 2014, 31 (04) :281-285
[42]   UTILITY OF OBSERVATION UNITS FOR YOUNG EMERGENCY DEPARTMENT CHEST PAIN PATIENTS [J].
Ely, Sora ;
Chandra, Abhinav ;
Mani, Giselle ;
Drake, Weiying ;
Freeman, Debbie ;
Limkakeng, Alexander T., Jr. .
JOURNAL OF EMERGENCY MEDICINE, 2013, 44 (02) :306-312
[43]   External validation of the GRACE risk score in patients with myocardial infarction in Hungary [J].
Ferenci, Tamas ;
Hari, Peter ;
Vajer, Peter ;
Janosi, Andras .
IJC HEART & VASCULATURE, 2023, 46
[44]   Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score [J].
Abazid, Rami M. ;
Pati, Nilkanth ;
Elrayes, Maged ;
Awadallah, Sameh ;
Ibrahim, Mohamed M. ;
Alaref, Amer ;
Bureau, Yves ;
Akincioglu, Cigdem ;
Bagur, Rodrigo ;
Tzemos, Nikolaos .
OPEN HEART, 2024, 11 (02)
[45]   The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers [J].
Schrader, Chet D. ;
Meyering, Stefan H. ;
Kumar, Darren ;
Alanis, Naomi ;
D'Etienne, James P. ;
Shaikh, Sajid ;
Vo, Vietvuong ;
Kamaria, Ankur R. ;
Huettner, Nicole ;
Wang, Hao .
HIGH BLOOD PRESSURE & CARDIOVASCULAR PREVENTION, 2021, 28 (01) :69-78
[46]   A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain [J].
Wang, Minghu ;
Hu, Zhiwei ;
Miao, Lihui ;
Shi, Manman ;
Gao, Qiang .
CLINICAL CARDIOLOGY, 2023, 46 (11) :1303-1309
[47]   Combining presentation high-sensitivity cardiac troponin I and glucose measurements to rule-out an acute myocardial infarction in patients presenting to emergency department with chest pain [J].
Greenslade, J. H. ;
Kavsak, P. ;
Parsonage, W. ;
Shortt, C. ;
Than, M. ;
Pickering, J. W. ;
Aldous, S. ;
Cullen, L. .
CLINICAL BIOCHEMISTRY, 2015, 48 (4-5) :288-291
[48]   Effect of the Emergency Department Assessment of Chest Pain Score on the Triage Performance in Patients With Chest Pain [J].
Zaboli, Arian ;
Ausserhofer, Dietmar ;
Sibilio, Serena ;
Toccolini, Elia ;
Bonora, Antonio ;
Giudiceandrea, Alberto ;
Rella, Eleonora ;
Paulmichl, Rupert ;
Pfeifer, Norbert ;
Turcato, Gianni .
AMERICAN JOURNAL OF CARDIOLOGY, 2021, 161 :12-18
[49]   Comparison of six decision aid rules for diagnosis of acute myocardial infarction in elderly patients presenting to the emergency department with acute chest pain [J].
Hrecko, Juraj ;
Dokoupil, Jiri ;
Pudil, Radek .
BRATISLAVA MEDICAL JOURNAL-BRATISLAVSKE LEKARSKE LISTY, 2022, 123 (04) :282-290
[50]   Predictive Factors and Risk Assessment for Hospitalization in Chest Pain Patients Admitted to the Emergency Department [J].
Kagansky, Nadya ;
Mazor, David ;
Wajdi, Ayashi ;
Yaron, Yulia Maler ;
Sharfman, Miya ;
Baran, Tomer Ziv ;
Kagansky, Dana ;
Pachys, Gal ;
Levy, Yochai ;
Trotzky, Daniel .
DIAGNOSTICS, 2024, 14 (23)