ST elevation myocardial infarction risk stratification and prognosis: Difference between revisions
No edit summary |
|||
| Line 4: | Line 4: | ||
==Overview== | ==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]]. | 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== | ==Risk Stratification in a Patient with ST Elevation MI== | ||
Revision as of 13:55, 7 May 2014
|
ST Elevation Myocardial Infarction Microchapters |
|
Differentiating ST elevation myocardial infarction from other Diseases |
|
Diagnosis |
|
Treatment |
|
|
Case Studies |
|
ST elevation myocardial infarction risk stratification and prognosis On the Web |
|
FDA on ST elevation myocardial infarction risk stratification and prognosis |
|
CDC on ST elevation myocardial infarction risk stratification and prognosis |
|
ST elevation myocardial infarction risk stratification and prognosis in the news |
|
Blogs on ST elevation myocardial infarction risk stratification and prognosis |
|
Directions to Hospitals Treating ST elevation myocardial infarction |
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.[1]
| 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 (%)[1] |
| 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
- ↑ 1.0 1.1 Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA; et al. (2000). "TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy". Circulation. 102 (17): 2031–7. PMID 11044416.