The primary end point for the study was death or nonfatal recurrent myocardial infarction. Patients received streptokinase, tenecteplase, altepase, or reteplase as well as 150 to 325 mg of nonenteric aspirin or 500 mg of IV aspirin unless previously received within the last 24 hours. The exclusion criteria for ExTRACT‐TIMI 25 included cardiogenic shock, pericarditis, symptoms of aortic dissection, contraindication to fibrinolysis, receipt of a low‐molecular‐weight heparin within an 8‐hour period prior to study entry, life expectancy of 2.5 mg/dL for men and >2.0 mg/dL for women). All patients had ≥20 minutes of ischemic symptoms while at rest and within 6 hours prior to randomization, ST‐segment elevation of ≥0.1 mV in 2 limb leads or of 0.2 mV in ≥2 contiguous precordial leads or left bundle‐branch block and were scheduled for fibrinolysis.
#Timi risk score trial
This clinical risk score, derived from a multivariable analysis, can be calculated at the bedside and is a dynamic updating of the TIMI risk score for STEMI at the time of discharge, conditional on having survived the index hospitalization.ĮxTRACT‐TIMI 25 was a double‐blinded, double‐dummy trial conducted at 674 sites in more than 48 countries, randomly assigning 20 506 STEMI patients to either enoxaparin or unfractionated heparin during the index hospitalization. Our primary goal is to present a new method of STEMI risk stratification that incorporates both initial assessment of risk as well as a discharge estimation of 1‐year mortality. Methods of prognostication that merge these populations do not take advantage of important information gathered in the first few days following the event. The wide spectrum of STEMI patients includes both those who are initially deemed high risk but have an uneventful hospital recovery as well as low‐risk patients who suffer major morbidity prior to discharge. Although some validated risk scores include in‐hospital events, there is a need for a risk stratification method that can be easily calculable at bedside, added as an arithmetic sum, and used as an additional component of an existing scoring system. 3– 6, 8 Patients are tied to the score they were assigned on admission without regard to their initial recovery from the index event. 9 Although each relies on a wide range of admission and peri‐PCI characteristics, these methods do not reclassify patients based on in‐hospital events. The TIMI risk score, 3 TIMI risk index, 8 GRACE risk index, 4 Zwolle primary PCI (percutaneous coronary intervention) risk index, 5 and CADILLAC risk score 6 are all prospectively validated predictors of both short‐ and long‐term mortality. Over the last 10 years, multiple methods of risk stratification for STEMI have been developed. It is well established that patients who have peri‐infarction morbidity are at increased risk for downstream events. 2– 6 The second level of assessment involves the identification of long‐term risk based on the development of postevent complications. At hospital admission, patients can be stratified by demographics, physical examination, and presenting signs, as well as initial laboratory and angiographic data. 1 The process of estimating the long‐term risk of morbidity and mortality after STEMI is based on 2 levels of assessment. This unique milieu produces post‐STEMI complications at a variable yet quantifiable rate. Patients suffering from ST‐elevation myocardial infarction (STEMI) have preexisting characteristics that vary across a range of severity. In the validation database, the C‐statistic was 0.81, with a NRI of 0.35 ( P=0.01). The C‐statistic produced by the dynamic score in the derivation database was 0.76, with a net reclassification improvement (NRI) of 0.33 ( P<0.0001) from the inclusion of dynamic events to the original TIMI risk score. The dynamic score included the development of in‐hospital MI, arrhythmia, major bleed, stroke, congestive heart failure, recurrent ischemia, and renal failure. Each variable was assigned an integer value based on the odds ratio, and the final score was the sum of these values.
#Timi risk score full
Variables with P<0.05 were incorporated into a full multivariable Cox model to assess the risk of death at 1 year. Each variable was tested individually in a univariate Cox proportional hazards regression. New variables were major clinical events occurring during the index hospitalization. Baseline variables were from the original TIMI risk score for STEMI. The dynamic TIMI risk score for STEMI was derived in ExTRACT‐TIMI 25 and validated in TRITON‐TIMI 38.
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