Less likely to receive timely reperfusion therapy.Less likely to undergo cardiac catheterization.Less likely to be treated with guideline-directed medical therapies.Chest pain associated with nausea/vomitingĬlinical factors that decrease likelihood of ACS/AMI:.Chest pain radiating to both arms > R arm > L arm.Type 5: Myocardial Infarction Related to CABG ProcedureĬlinical factors that increase likelihood of ACS/AMI:.Type 4: Myocardial Infarction Associated With Revascularization Procedure. Sudden cardiac death with symptoms suggestive of myocardial ischaemia without elevated biomarkers.Type 3: Cardiac Death Due to Myocardial Infarction.coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias) Condition other than CAD contributes to an imbalance between myocardial oxygen supply and/or demand (e.g.Type 2: Myocardial Infarction Secondary to an Ischemic Imbalance.Atherosclerotic plaque rupture or intraluminal thrombus in one or more of the coronary arteries.Type 1: Spontaneous Myocardial Infarction.NSTEMI includes Type 2 -Type 5 biomarker elevations.Association between quantity of troponin and risk of death.Age >65 with MI and anemia had 33% reduction in 30 day mort if transfused to keep HCT >30.5% of NSTEMI will develop Cardiogenic Shock (60% mortality).33% with confirmed MI have no chest pain on presentation (especially older, female, DM, CHF).5.4 Unstable Angina - NSTEMI Guidelines.A multi-center, controlled clinical trial. Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. Selker HP, Beshansky JR, Griffith JL, et al. A prospective multicenter clinical trial. A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. Pozen MW, D’Agostino RB, Selker HP, et al. Prediction of the need for intensive care in patients who come to the emergency departments with acute chest pain. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. A neural computational aid to the diagnosis of acute myocardial infarction. Meta-regression analysis revealed a strong linear relation between TIMI risk score (p < 0.001) and the cumulative incidence of cardiac events.Īlthough the TIMI risk score is an effective risk stratification tool for patients in the emergency department with potential acute coronary syndromes, it should not be used as the sole means of determining patient disposition.īaxt WG, Shofer FS, Sites FD, et al. Data were available for meta-analysis in 8 of the 10 studies. We included 10 prospective cohort studies (with a total of 17 265 patients) in our systematic review. We performed a meta-regression to determine whether a linear relation exists between TIMI risk score and the cumulative incidence of cardiac events. We included prospective cohort studies that validated the TIMI risk score in emergency department patients. We searched five electronic databases, hand-searched reference lists of included studies and contacted content experts to identify articles for review. We sought to expand the clinical application of the TIMI risk score by assessing its prognostic accuracy in patients in the emergency department with potential acute coronary syndromes. It was originally developed for use in patients with unstable angina or non-ST-elevation myocardial infarction. The Thrombolysis in Myocardial Infarction (TIMI) risk score uses clinical data to predict the short-term risk of acute myocardial infarction, coronary revascularization or death from any cause.
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