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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

      The 1.4 million patients admitted with unstable angina pectoris and non–ST-elevation myocardial infarction (UAP/NSTEMI) each year are a heterogenous population with varying risks of death and recurrent cardiac events. The Thrombolysis In Myocardial Infarction (TIMI) risk score for UAP/NSTEMI was created to better stratify patients according to easily obtainable information gathered from the initial history, electrocardiogram, and cardiac markers.
      • Antman E.M.
      • Cohen M.
      • Bernink P.J.
      • McCabe C.H.
      • Horacek T.
      • Papuchis G.
      • Mautner B.
      • Corbalan R.
      • Radley D.
      • Braunwald E.
      The TIMI risk score for unstable angina/non-ST elevation MI a method for prognostication and therapeutic decision making.
      The TIMI risk score was derived and validated in the TIMI 11B and Efficacy and Safety of Subcutaneous Enoxaparin in Non–Q-wave Coronary Events (ESSENCE) trials and accurately predicted adverse outcomes through 14 days. It has also been applied in the Platelet Receptor Inhibition for Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) and Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS)-TIMI 18 Trials.
      • Morrow D.A.
      • Antman E.M.
      • Snapinn S.M.
      • McCabe C.H.
      • Theroux P.
      • Braunwald E.
      An integrated clinical approach to predicting the benefit of tirofiban in non-ST elevation acute coronary syndromes application of the TIMI risk score for UA/NSTEMI in PRISM-PLUS.
      ,
      • Cannon C.P.
      • Weintraub W.S.
      • Demopoulos L.A.
      • Vicari R.
      • Frey M.J.
      • Lakkis N.
      • Neumann F.J.
      • Robertson D.H.
      • DeLucca P.T.
      • DiBattiste P.M.
      • Gibson C.M.
      • Braunwald E.
      Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.
      However, because clinical trials of UAP/NSTEMI usually select higher risk patients (with electrocardiographic changes and/or positive cardiac markers), there has been questions whether the TIMI risk score would be valid in an unselected population of patients representative of general clinical practice. The goal of this study was to validate the TIMI risk score in a large unselected population of patients with UAP/NSTEMI and assess its long-term predictive value.
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