ST elevation myocardial infarction risk stratification and prognosis

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Risk calculators and risk factors for ST elevation myocardial infarction risk stratification and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Two main risk-stratification scores are used when assessing a patient with ST elevation MI and acute coronary syndromes; the TIMI Risk Score (for STEMI), and the GRACE risk score (for acute coronary syndrome.

Risk Stratification in a Patient with ST Elevation MI

• The Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI:
  • The TIMI risk score for STEMI was created from simple arithmetic sum of independent predictors of mortality weighted according to the adjusted odds ratios from logistic regression analysis.
  • The risk score was derived from 14,114 patients enrolled in the Intravenous nPA for Treatment of Infarcting Myocardium Early II trial (TIME II).
  • The TIMI risk score was subsequently validated in an unselected heterogeneous community population through the National Registry of Myocardial Infarction (NRMI) 3 & 4.

The TIMI risk score for TIMI is calculated by adding the numbers assigned to the different criteria shown below. The total possible score is 14.

Risk Factor	Points
Demographic data and medical history
Age ≥75 years	3
Age 65–74 years	2
History of diabetes mellitus or hypertension or angina	1
Physical examination
Systolic blood pressure <100	3
Heart rate >100	2
Killip class II–IV	2
Weight <67 kg	1
Evaluation at presentation
Anterior ST elevation or left bundle branch block	1
Time to therapy >4 hours	1

Interpretation of TIMI Risk Score for STEMI

Score	30 Day Mortality (%)
0	0.8%
1	1.6%
2	2.2%
3	4.4%
4	7.3%
5	12.4%
6	16.1%
7	23.4%
8	26.8%
>8	35.9%

• The Global Registry of Acute Coronary Events (GRACE) risk score for ACS:
  • The GRACE risk score was created from a multivariable logistic regression model using ACS patients enrolled in the GRACE registry (N=11389).
  • The GRACE risk score was validated using subsequent cohort of patients enrolled in GRACE (n=3972) and the Global Use of Strategies to Open Occluded Coronary Arteries IIb (GUSTO-IIb) trial (n=12142).
• The AHA/ACCA Guidelines for Unstable Angina/Non -ST-Elevation Myocardial Infarction provide guidelines for risk stratification for ACS.

References

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