Clinical InvestigationAcute Ischemic Heart DiseasePerformance of the Thrombolysis in Myocardial Infarction (TIMI) ST-elevation myocardial infarction risk score in a national cohort of elderly patients
Section snippets
Cooperative Cardiovascular Project
The CCP included fee-for-service Medicare beneficiaries discharged from an acute care nongovernmental hospital in the United States with a primary discharge diagnosis of acute MI (International Classification of Diseases, Ninth Revision, Clinical Modification code 410) between January 1994 and February 1996, with the exception of readmissions (code 410. × 2).15 These patients' records were centrally abstracted for detailed clinical data including medical history, presentation, inhospital
Patient characteristics
Patients in the study cohort were predominantly white, 76 years of age on average, and slightly less than half were female. Reperfusion therapy was provided to 17 579 patients (36.7%), with 14 858 patients (84.5% of patients receiving reperfusion therapy) receiving fibrinolytic therapy and 2721 patients receiving a primary percutaneous transluminal coronary angioplasty. Patients who received reperfusion therapy were younger and a greater proportion were male, white, and had fewer comorbid
Discussion
Our evaluation of the TIMI score in a national, community-based population of elderly patients hospitalized with STEMI found the TIMI score provided only modest prognostic discrimination and calibration. Furthermore, published estimates of the 30-day mortality rates for TIMI scores were lower than those observed in the CCP cohort. Together, these data indicate the TIMI score may not accurately predict prognosis among elderly patients with STEMI.
Our evaluation of the TIMI score highlights how a
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Saif Rathore was supported by NIH/National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.