Patients admitted to the emergency department for suspected ACS and who were subsequently discharged without an acute cardiovascular event have higher mortality in association with mildly elevated troponin (after 2 and 5.8 years of follow-up). Troponin is considered an independent risk factor for all-cause mortality in the general population (without ACS). Physiological changes in older patients may be responsible for such results. Low troponin levels are associated more with high mortality in older patients with ACS than with younger patients. However, the prognostic value is attenuated in older patients. Current ESC guidelines recommend that troponin should be measured serially to determine the prognosis in patients with ACS (Class I, level B). High troponin levels predict an increased risk of mortality, and high-sensitivity troponin (hs-Tn)-T seems to be a better predictor than hs-Tn-I. Current European Society of Cardiology (ESC) guidelines recommend the use of NT-proBNP as a prognostic factor in patients with ACS (Class IIa, level B), but the use of other biomarkers is not recommended. An elevated NT-proBNP level in a patient with ACS successfully predicts a worse prognosis (mortality, development of left ventricular systolic dysfunction). It has been suggested that an elevated N-terminal fraction of brain natriuretic peptide (NT-proBNP) level may be caused by transient myocardial ischemia, even without left ventricular systolic dysfunction. 2012 59(23):2091-8.Several biomarkers have been proposed to define the prognosis of patients with ACS, many of which are routinely used in everyday clinical practice. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. Prospective validation of the thrombolysis in myocardial infarction risk score in the emergency department chest pain population. Ĭhase M, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE. Validation of the thrombolysis in myocardial infarction (TIMI) risk score for unstable angina pectoris and non-ST-elevation myocardial infarction in the TIMI III registry. Scirica BM, Cannon CP, Antman EM, Murphy SA, Morrow DA, Sabatine MS, McCabe CH, Gibson CM, Braunwald E. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making JAMA. Many guidelines recommend higher risk levels receiving more aggressive medical intervention and/or receiving early invasive management.Īntman EM, Cohen M, Bernink PJLM, McCabe CH, Hoacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E. If patients are in the 0 or 1 point group, they should be further risk stratified using another risk score or one’s own institutional practices, as risk is not low enough to safely discharge from the hospital. Newer chest pain risk scores such as the HEART Score have been shown to better stratify risk than the TIMI Score, particularly in the undifferentiated chest pain patient. Unclear if this risk score can be used in patients with chest pain in the setting of cocaine use. Originally derived with patients with known unstable angina or NSTEMI. TIMI Risk Score for unstable angina/NSTEMI was developed as one of the earliest chest pain decision rules that was widely implemented. Patients who have a higher risk score may require more aggressive medical or procedural intervention. Patients with a score of 0 or 1 point are at lower risk of adverse outcome (death, MI, urgent revascularization) compared to patients with a higher risk score. Validation studies showed 1.7 to 2.1% of patients with a score of 0 still had adverse outcomes within 30 days. The original study showed 4.7% of patients with a score of 0 or 1 had adverse outcomes within 14 days. ScoreĪ TIMI risk score of 0 or 1 does not equal zero risk of adverse outcome. NB!!! A TIMI Risk Score of 0 does not equate to zero risk of adverse outcome. *Risk factors for CAD: Family history of CAD, hypertension, hypercholesterolemia, diabetes, or current smoker (thanks to Jeff Geske at Mayo for this update!) Interpretation of results: TIMI UA/NSTEMI assessment as addition of the selected points: Criteria Risk at 14 days of: all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization Hypertension, hypercholesterolemia, diabetes, family history of CAD, or current smoker:Ī TIMI Risk Score of 0 does not equate to zero risk of adverse outcome.ĭownload result as PDF file Patient’s score
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