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A prospective investigation of the prognostic value of "TIMI" and "Front Door TIMI" in Chinese patients presenting to the emergency department with undifferentiated chest pain [Abstract]

Graham, C. A., Chan, J. W., Rotheray, K. R. and Rainer, Timothy 2011. A prospective investigation of the prognostic value of "TIMI" and "Front Door TIMI" in Chinese patients presenting to the emergency department with undifferentiated chest pain [Abstract]. Annals of Emergency Medicine 58 (4) , S210. 10.1016/j.annemergmed.2011.06.123

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Abstract

Study Objective: Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) and front door Thrombolysis in Myocardial Infarction risk score (FDTIMI-RS) have been proven to be useful to risk stratify chest pain patients in many Western countries, but it has not been validated in Asian countries. We hypothesised that the TIMI-RS would be a valid tool in the Hong Kong Chinese population. The aim of this study was to establish the relationship between TIMI-RS and FDTIMI-RS and the 30-day rate of major adverse cardiac outcomes (MACE) of patients with chest pain. Methods Design: Single center prospective observational cohort study. Participants: Consecutive ED patients presenting with chest pain were enrolled from July 2009 until March 2010. Data collection: patient characteristics, TIMI-RS items and past medical and medication history. Primary outcome: MACE within 30 days of ED presentation. MACE is defined as a composite outcome which is fulfilled if any of the following occurs: death (all causes), readmission with myocardial infarction (MI), acute coronary syndrome not diagnosed at initial ED presentation, and percutaneous coronary intervention. Results: 1000 patients were recruited and 30-day follow-up was completed on all patients. Patients had a mean age of 66.7±14 years and 54% were male. 169 (17%) patients had a MACE within 30 days of ED presentation. The incidence of MACE in each TIMI-RS group is as follows: TIMI-RS 0, 1/145, (0.7%); TIMI-RS 1, 21/249 (8.4%); TIMI-RS 2, 44/239, (18.4%); TIMI-RS 3, 40/179, (22.3%); TIMI-RS 4, 42/122, (34.4%), TIMI-RS 5, 14/52, (26.9%), TIMI-RS 6/7, 7/14, (50%). There was an excellent correlation between TIMI-RS and MACE (ρ=0.964, p <0.001). Increasing FDTIMI-RS was also associated with increased risk of MACE within 30 days (ρ= 1, p=0.01). Conclusion: The TIMI-RS and FDTIMI-RS may be useful tools for risk stratification of ED patients with undifferentiated chest pain. However, patients in the low risk group still had a risk of having MACE (0.7% for TIMI-RS=0 and 1.3% for FDTIMI-RS=0). Therefore, while the scores can guide patient disposition from the ED, they cannot fully replace clinical judgement.

Item Type: Article
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: ACEP Research Forum 2011
Publisher: Elsevier
ISSN: 0196-0644
Last Modified: 04 Jun 2017 09:15
URI: http://orca-mwe.cf.ac.uk/id/eprint/92690

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