MORTALITY OF ACUTE MYOCARDIAL INFARCTION IN RELATION WITH TIMI RISK SCORE

Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score is said to be an important factor in predicting mortality risk in fibrinolysis-eligible STEMI patients. An attempt was made to assess the situation by comparing risk stratification based on the TIMI score with the hospital outcome of such individuals. Methods: 145 STEMI patients were included in this srudy , TIMI risk scores were calculated and analysed vis-Ã -vis various relevant parameters.. Based on their TIMI scores, the patients were placed into three risk groups: low-risk,moderate-risk, and high-risk. All patients received standard anti-ischemic medication, were thrombolyzed, monitored in the ICCU, and monitored throughout their hospital stay for post-MI sequelae. Results: According to the TIMI risk score, 79 patients (54.5%) had low-risk , 48 (33.1%) to the moderate-risk , and 18 (12.4%) to the high-risk . The highest mortality rate (total 17 deaths) was found in the high-risk group (55.6%), followed by moderate-risk (12.2%) and low-risk (1.28%) groups, respectively. Killips categorization grade 2-4 had the highest relative risk (RR-15.85) of the seven potentially dubious variables evaluated, followed by systolic BP 100mmHg (RR-10.48), diabetes mellitus (RR-2.79), and age >65 years (RR- 2.59). Conclusions: In patients with STEMI, the TIMI risk scoring system appears to be a straightforward, valid, and practical bedside tool for quantitative risk classification and short-term prognosis prediction.

Risk Stratification of Patients Undergoing Primary Pci for Stemi Using Dynamic Timi Risk Score at A Tertiary Care Cardiac Center

Objective: To determine the frequency of severity based on dynamic TIMI scoring among STEMI patients undergoing primary PCI at a tertiary care Cardiac center. Subject and Methods: This case series study was carried out on 171 patients admitted with acute STEMI undergoing PPCI at the department of cardiology NICVD, Karachi for six months from February 1st to July 30th, 2018. After the selection of patients, they were shifted to the Cath lab, the arterial sheath was passed through the femoral route only although the radial route is also present but to reduce the bias we choose the same femoral route only. Angiography was done and the area of occlusion identified was ballooned/stented by the interventional cardiologist having experience of at least 03 years. The study parameters of dynamic TIMI risk score points were recorded on a predesigned proforma. Results: The mean age of the patients of the study subjects was 59.89±12.67, Distribution of gender was stated, 133(77.78%) patients were male and (22.22%) were female. Outcome dynamic TIMI risk score severity was stated, 86(50.29%) patients had a low risk, 62(36.26%) patients had a moderate risk, 23(13.45%) patients had a high risk. Conclusion: When used in STEMI patients, this new approach shows the ever-changing risks and could be helpful in clinical decision-making as well as risk assessment. Keywords: ST-segment elevation myocardial infarction; Primary percutaneous coronary intervention, TIMI

Cardiac magnetic resonance imaging improves prognostic stratification of patients with ST-elevation myocardial infarction and preserved ejection fraction

Aims To evaluate the prognostic validity of clinical risk factors as well as infarct characterization and myocardial deformation by cardiac magnetic resonance (CMR) in ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF) following primary percutaneous coronary intervention (PCI). Methods and Results This multicenter, individual patient-data analysis from two large CMR trials included 1247 STEMI patients. CMR examinations were conducted 3 (interquartile range[IQR]:2-4) days after PCI. LVEF, infarct size, microvascular obstruction (MVO) and myocardial strain values were measured. Primary endpoint was defined as composite of major adverse cardiovascular events (MACE) including death, re-infarction and congestive heart failure. A preserved LVEF (defined as LVEF ≥50%) was observed in 724 patients (=58%). In the overall cohort, 97 patients experienced a MACE event (follow-up time 12 [IQR:12-13] months), and 34 MACE events occurred in the group with preserved LVEF (5%, versus 12% incidence rate in patients with LVEF<50%). TIMI risk score (hazard ratio[HR]:1.28[95%CI:1.02-1.59];p=0.03) and female gender (HR:2.24[95%CI:1.10-4.57];p=0.03) emerged as independent clinical determinants of MACE in the patient group with preserved LVEF. Among CMR parameters, presence of MVO (HR:2.39[95%CI:1.05-5.46];p=0.04) and reduced global longitudinal strain (GLS; HR:1.12[95%CI:1.02-1.23];p=0.02) independently predicted MACE in the LVEF-preserved population. The addition of MVO and GLS to the clinical prognostic markers (TIMI risk score, female gender) increased (p = 0.02) the prognostic validity (AUC:0.76[95%CI:0.73-0.79]) compared to the clinical markers alone (AUC:0.65[0.62-0.69]). Conclusion In contemporary treated STEMI patients showing preserved LVEF, a CMR-based risk prediction approach assessing MVO and GLS provided strong prognostic value that was incremental to clinical outcome parameters.

Value of TIMI Risk Score Combined With Global Longitudinal Strain for Predicting Major Adverse Cardiac Events After PCI in Patients With ST-Segment Elevation Myocardial Infarction

PurposeAccurately assessing the predicting prognosis is important in ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the predictive value of the TIMI risk score combined with GLS for the occurrence of major adverse cardiovascular events (MACEs)in STEMI patients after percutaneous coronary intervention (PCI)MethodsAcute STEMI diagnosed between January 2019 to June 2021 were prospectively enrolled. GLS were performed to assess left ventricular dysfunction three days post-percutaneous coronary intervention (PCI). In a 12-month follow up, three prognostic models for MACE were established based on TIMI risk score alone, TIMI risk score + GLS, and TIMI risk score + GLS + clinical risk factors, respectively, and assessed for efficiency.ResultsA total of 138 patients were enrolled. According to the follow-up results, the incidence of MACE in the patients was 19.6% (27/138). Areas under the receiver operating characteristic (ROC) curves were 0.703, 0.810 and 0.815, respectively, in TIMI risk score alone, TIMI risk score + GLS, TIMI risk score + GLS + clinical risk factors, indicating a significantly higher value and more efficient assessment for TIMI risk score + GLS.ConclusionCompared with the TIMI risk score alone, TIMI risk score combined with GLS provides a more efficient assessment of risk for determining the prognosis of STEMI patients.

Results of treatment of myocardial infarction with ST-segment elevation using early and delayed coronary interventions in different age groups

The aim of the study was to assess the treatment results in patients with anterior STEMI using primary PCI in different patient age groups, including those at late hospitalization, taking into account the initial mortality risk (MR). The study included 804 patients with anterior STEMI, aged 28 to 91 years, who were admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2017: 583 of them had the primary PCI performed either within the first 12 hours from the disease onset (311 patients) or at late hospitalization: after 12–72 hours (272 patients); and 221 patients treated without PCI. The distribution of patients by age: under 65 years old, 65–75 years old, and over 75 years old was 340, 139, and 104 in the PCI group, and 126, 47, and 48 in the group without PCI, respectively. In 26 death cases after PCI and in 39 of died without interventions, the state of the coronary bed, the affected area, and the immediate cause of death were determined. We have found that in the absence of reperfusion therapy (RT) in STEMI, the initially high baseline MR assessed by TIMI Risk Score corresponds to high mortality. It affects people of predominantly elderly and, especially, senile age, who more often have a proximal lesion of the main coronary arteries, which causes an extensive area of infarction with the development of fatal complications. The use of primary PCIs, including those at late hospitalization, prevents the progression of acute heart failure, the formation of LV aneurysms, and reduces the deaths rate. In different periods of time, the mortality rate with the use of primary PCI, including the delayed ones, fluctuates; it can rise with a significantly increasing number of the hospitalized at senile age. An increase in mortality is associated with complications, including those arising during procedures in severe multivessel coronary artery disease, which is more common in this patient population. Achieving angiographic success even in the absence of ECG signs of reperfusion can significantly reduce mortality in all age groups. High MR is an optimal indication for using delayed procedures. An urgent use of primary PCIs, including those at late hospitalization, allows the optimization of the STEMI treatment, and the achievement of the maximum reduction in mortality.

Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries

BackgroundThyroid function is closely involved in cardiovascular diseases. The free triiodothyronine (fT3) to free thyroxine (fT4) ratio has been reported as a risk factor for coronary artery disease, but its prognostic value in euthyroid patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear.MethodsA total of 1162 euthyroid patients with MINOCA were enrolled and divided according to decreased tertiles of fT3/fT4 ratio. The study endpoint was major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were performed.ResultsPatients with lower fT3/fT4 tertile levels had a significantly higher incidence of MACE (10.0%, 13.9%, 18.2%; p=0.005) over the median follow-up of 41.7 months. The risk of MACE increased with the decreasing fT3/fT4 tertiles even after multivariate adjustment (tertile1 as reference, tertile2: HR 1.58, 95% CI: 1.05-2.39, p=0.030; tertile3: HR 2.06, 95% CI: 1.17-3.11, p=0.006). Lower level of fT3/fT4 ratio remained a robust predictor of MACE in overall (HR 1.64, 95% CI: 1.18-2.29, p=0.003) and in subgroups. When adding fT3/fT4 ratio [area under the curve (AUC) 0.61] into the thrombolysis in myocardial infarction (TIMI) risk score (AUC 0.69), the combined model (AUC 0.74) yielded a significant improvement in discrimination for MACE (ΔAUC 0.05, p=0.023).ConclusionsLow level of fT3/fT4 ratio was strongly associated with a poor prognosis in euthyroid patients with MINOCA. Routine assessment of fT3/fT4 ratio may facilitate risk stratification in this specific population.

Complications Associated to High TIMI Score in Patients with Acute ST Elevation Myocardial Infarction

Objective: To determine the complications associated to High TIMI risk score among patients presented with acute ST elevation myocardial infarction. Study Design: Cross sectional Place & Duration: Study was conducted at Cardiac Centre of Pakistan Institute of Medical Sciences (PIMS), Islamabadfor duration of 6 months from January to June, 2020. Methods: Total 290 patients of both genders with ages 35 to 80 years presented with acute myocardial infarction were included in this study. Patients detailed medical history including age, sex and residence were recorded. Thrombolysis in Myocardial Infarction (TIMI) risk score was calculated for each patient. Follow up was taken during the hospital stay and after discharge. Complications were recorded on follow-up. Data was analyzed by SPSS 21.0. Results: From all the patients high TIMI score was found in 34.48% patients. Out of 100 patients 70% were male and 30% were females with mean age 54.25+12.65 years. According to the high TIMI score 100 (34.48%) patients had score above 8 and 190 (65.52%) had score less than 8. Complications were recorded ad Ventricular fibrillation, VT, AF, Heart block, cardiogenic shock and pulmonary edema in 17%, 13%, 2%, 7%, 24% and 24% patients respectively.15% patients were died during hospital stay. 28% patients had post infarct angina, 9% patients had stroke and 28% patients treated revascularization. Conclusion: We concluded from this study that frequency of high TIMI score is high in our setting and we patients with increase score had high risk of complications and mortality. Keywords: High Thrombolysis in Myocardial Infarction, Acute ST Elevation Myocardial Infarction, Frequency, Complications, Mortality.

Is neutrophil lymphocyte ratio a prognostic marker of acute ST elevation myocardial infarction?

Several inflammatory biomarkers have been implicated in the pathogenesis of acute coronary syndromes. The present study aims to determine the prognostic value of neutrophil lymphocyte ratio (NLR) to predict the immediate outcomes in patients with acute ST elevation myocardial infarction and if any correlation exists between NLR and TIMI risk score. A review of articles published in Pubmed database on the prognostic importance of neutrophil lymphocyte ratio in determining major adverse cardiac events (MACE) such as arrhythmias, cardiogenic shock and in hospital mortality was done. NLR was found to be a reliable prognostic tool to assess the immediate outcome in ST elevation myocardial infarction (STEMI) patients.