Lukes please refer to the minnesota stemi guideline for further information, or if transferring to a pci hospital outside of duluth page 1 of 2 essentiast. Stemi extensive anterior wall onset 4 hours killip i timi. The dynamic timi risk score for stemi was derived in extracttimi 25 and validated in tritontimi 38. Timi risk score predicts death in stemi patients medscape. May 23, 2015 however, this analysis was based on uk nstemi patients in 1998 and 1999, and may not be applicable to a contemporary nstemi population either in the uk or elsewhere. Gender, timi risk score and inhospital mortality in stemi. Reynolds cad risk timi risk score stemi valiant heart failure risk score grace the grace acs risk calculator estimates risk of death following acute coronary syndrome acs pretest probability of cad cad consortium determine pretest probability of coronary artery disease in. The timi risk score for unstable anginanonst elevation. The maximum possible risk score is 14 points and the minimum 0. This score was developed based on thrombolytic outcomes, which likely have worse outcomes when compared to pci. The timi risk score for stemi is also useful for patients with known stemi.
To facilitate the rapid and efficient treatment of patients experiencing an st elevation myocardial infarction stemi with percutaneous coronary intervention pci. Application of risks scores in acute coronary syndromes. Patients with st elevation acute myocardial infarction stemi comprise a he terogeneous population with respect to the risk for adverse events. Stemi st elevation should be reported to the receiving facility medications to give. New risk score for patients with acute chest pain, nonstsegment deviation, and normal troponin concentrations. To validate the timi risk score in a population of stemi patients reflective of contemporary practice. As noted in the guideline, stemi comprises 2540% of the 683,000 u.
Risk stratification is defined as a statistical process to determine detectable characteristics associated with an increased chance of experiencing unwanted outcomes. The calculator thrombolysis in myocardial infarction timi score for st elevation acute myocardial infarction is used as a simple arithmetic sum of independent predictors of mortality. The result obtained in this timi risk score for stemi calculator permits an informed medical decision in the following steps, usually thrombolysis or percutaneous coronary intervention, based on the level of mortality risk of each patient. A dynamic risk score provides an initial risk stratification and reassessment at discharge.
A metaanalysis involving 36 studies with nearly 117,000 nstemi patients has concluded that the grace global registry of acute cardiac events risk score jama 2004. The crusade score contains eight criteria with varying point values defining bleeding risk as follows. Timi risk score for st elevation acute mi stemi patient at presentation with st elevation mi chest pain 30min, symptom onset stemi guideline. When a patient presents with an acute stemi, the optimal treatment is usually clear proceed to pci immediately. Twelve independent predictors of mortality were identified.
A plethora of these risk scoring systems are in use today. Longterm outcomes in highrisk patients with nonstsegment. The timi risk score for stemi predicts inhospital mortality. Out of 100 patients, 35% of the patients were diabetic, 45% were hypertensive, 41% of patients were smoker, 33% of them were dyslipedemic although 24% have no record of their lipid level and 14% have positive family history of ischemic heart disease table2. A simple timi risk score11 has been validated and can be used. The timi risk score for unstable anginanonst elevation mi.
Epicor developed a risk score for mortality in patients with stemi n 4943 and nonstelevation acs n 5625. The ems agency is a branch of the emergency management department. The parameters for the calculator include dm, history of htn or angina, systolic blood pressure, heart rate, killip class iiiv, body weight, anterior lead st elevation of left bbb, time to treat, age. Pdf the utility of the timi risk index on admission for predicting. The timi risk score for stemi may help a cardiology, medical andor intensive care team with weighing risk benefit of medications like anticoagulation and invasive procedures by knowing a patients baseline risk. Please contact the ems agencys clinical staff for questions regarding these documents, 951 358.
Thrombolysis in myocardial infarction timi score for stemi. Risk score may allow for discharge of stemi patients nurse. It comprises of 7 factors that are evaluated through a simple questionnaire, each of the answers being given a certain amount of points. Reynolds cad risk timi risk score stemi valiant heart failure risk score grace the grace acs risk calculator estimates risk of death following acute coronary syndrome acs pretest probability of cad cad consortium determine pretest probability of coronary artery disease in patients with chest pain. Event rates increased significantly as the timi risk score increased in the test cohort in timi 11b and this pattern of increase was confirmed in the validation cohorts. Acute myocardial infarction and stemiequivalent patterns. The timi risk score evaluates risk of ischemic events and mortality in patients diagnosed with st elevation myocardial infarction based on clinical data such as systolic blood pressure, killip class or history of diabetes. Pdf acute myocardial infarction and stemiequivalent.
Results the 7 timi risk score predictor variables were age 65 years or older, at least 3 risk factors for coronary artery disease, prior coronary stenosis of 50% or more, stsegment deviation on electrocardiogram at presentation, at least 2 anginal events in prior 24 hours, use of aspirin in prior 7 days, and elevated serum cardiac markers. The most common symptom is chest pain, often radiating to the left shoulder 2 or angle of the jaw, crushing, central and associated with nausea. Performance of the timi risk score in predicting mortality after. Lsuhscshreveport has declared itself as a primary pci facility in the treatment of patients experiencing a stemi. It has been well validated in patients with stemi treated both with fibrinolysis and primary pci 7.
When applied to acs risk stratification has helped target healthcare resources and guide clinicians as to revascularisation requirement, urgency and method. Creatinine clearance cockcroft gault equation gfr calculators. Pdf dynamic timi risk score for stemi researchgate. Timi study group application of the timi risk score for st. Rr relative risk rrr relative risk reduction steacs stelevation acute coronary syndrome stemi stelevation myocardial infarction synergy superior yield of the new strategy of enoxaparin, revascularization and glycoprotein iibiiia inhibitors trial syntax synergy between percutaneous coronary intervention with taxus and cardiac surgery.
Baseline variables were from the original timi risk score for stemi. With non stemi patients faring as badly as those with more severe acs events, investigators say that the late mortality in non stemi is underrecognized and that more attention should be paid to. Though these patients have a clear protocol normally thrombolysis or percutaneous coronary intervention and are already high risk for mortality, the timi risk score for stemi provide risk stratification which helps treatment decisions after acute issues have been. Esc guidelines for the management of acute coronary syndromes. Patients with stemi are generally considered at risk for ischemic complications. The timi risk score could, thus, be suitable for early risk stratification and subsequent treatment of stemi patients who receive reperfusion therapy, morrow et al conclude. The timi risk score for stemi predicts inhospital mortality and. A report of the american college of cardiology foundationamerican heart association task force on practice guidelines. Female gender was not included in the timi risk score, as it was one of the five variables accounting for the remaining 3% of the predictive capacity for 30day mortality or 1.
The risk stratification table 1 is necessary for prognosis assessment and treatment. The study consisted of 100 patients out of which 19 were females and 81 were males. This page is used by the county of riverside ems agency to host the stemi system program documents. Criteri di alto rischio per linfarto miocardico acuto con sopraslivellamento del tratto st in una strategia di rete. Ems preactivated yes no emergency department to complete onset chest pain time ed arrival time ecg time means of transport to ed selffamily ambulance call. Although there are multiple methods of risk stratification for st. It was concluded that in patients with uanstemi, the timi risk score can facilitate decision making and stratify mortality risk.
Thrombolysis in myocardial infarction timi score for. Presenza di segni di scompenso classe killip 1 pressione arteriosa 100 bmin eta avanzata 75 anni. The thrombolysis in myocardial infarction timi risk score trs, and the timi risk. A 12lead ecg must be obtained as soon as possible, with a target delay of. The risk score was evaluated among 84 029 patients with stemi from the national registry of myocardial infarction 3 nrmi 3, which collected data on consecutive patients with myocardial infarction. Patients with st elevation acute myocardial infarction stemi comprise a heterogeneous population with respect to the risk for adverse events.
The parameters for the calculator include dm, history of htn or angina, systolic blood pressure, heart rate, killip class iiiv, body weight, anterior lead st. I the thrombolysis in myocardial infarction timi risk score for stelevation myocardial infarction stemi is a 8 items scoring system developed to predict the risk of death from any cause at 30 days in patients with stemi. Risk score may allow for discharge of stemi patients a simpletouse risk score can identify low risk patients following a stelevation myocardial infarction and may provide an opportunity to employ early discharge strategies to reduce length of hospital stay and save hospital costs without compromising the safety of the patient, according to a. Stemi extensive anterior wall onset 4 hours killip i timi score 314. Unclear if this risk score can be used in patients with. Adults with nonstsegmentelevation myocardial infarction nstemi or unstable angina are assessed for their risk of future adverse cardiovascular events using an established risk scoring system that predicts 6month mortality to guide clinical management. It is a tool that differentiates nonstemi from stemi ischemic events. Stemi extensive anterior wall onset 4 hours killip i timi score 314 free download as powerpoint presentation. The timi risk score for stemi was assessed in an external data set from the timi 9 trial. Conclusions in patients with uanstemi, the timi risk score is a simple.
A timi risk score of 0 or 1 does not equal zero risk of adverse outcome. However, this analysis was based on uk nstemi patients in 1998 and 1999, and may not be applicable to a contemporary nstemi population either in the uk or elsewhere. Readiness for cpr andor defibrillation obtain 12lead ecg. Patient data sheet ed physician family cell phone ed phone. Risk score may allow for discharge of stemi patients a simpletouse risk score can identify lowrisk patients following a stelevation myocardial infarction and may provide an opportunity to employ early discharge strategies to reduce length of hospital stay and save hospital costs without compromising the safety of the patient, according to a. I in patients with uanstemi, this timi risk score is a simple prognostication scheme that categorizes the risk of death and ischemic events and provides a basis for therapeutic decision making. Pdf acute myocardial infarction and stemiequivalent patterns.
Risk score may allow for discharge of stemi patients. Timi risk score for secondary prevention trs 2p timi risk score for hf in diabetes trshfdm bmi. Ecg monitoring must be initiated as soon as possible in all patients with suspected stemi. We also examine the need for a risk score for those patients presenting with stemi. Which is the best choice for a cardiologist as an aid to decision making. Aug 16, 2000 results the 7 timi risk score predictor variables were age 65 years or older, at least 3 risk factors for coronary artery disease, prior coronary stenosis of 50% or more, stsegment deviation on electrocardiogram at presentation, at least 2 anginal events in prior 24 hours, use of aspirin in prior 7 days, and elevated serum cardiac markers. A method for prognostication and therapeutic decision making. Grace, timi for stemi, pursuit, sri, emmace, cacs, cha2ds2vaschs, action registrygwtg and. Ems preactivated yes no emergency department to complete onset chest pain time ed arrival time ecg time. Timi 9a and 9b were multicenter randomized trials evaluating the safety and efficacy of hirudin as an adjunct to fibrinolytic therapy tissue plasminogen activator or streptokinase at the physicians discretion. Emergency care management, including diagnosis and treatment, starts at the point of first medical contact. The dynamic timi risk score for stemi retains all the ben e. This was a retrospective analysis of elderly 65 years female patients who underwent ppci for stelevated myocardial infarction stemi from. A timi score risk and a timi score in general, patients having multiple coronary risk factors.