The TIMI risk score has been validated in the emergency department (ED) setting as a tool for risk stratification of patients presenting with chest pain. The TIMI risk score is a 7‐point scale that includes 7 factors: age ≥ 65, ≥ 3 coronary artery disease (CAD) risk factors (positive family history, hypertension, hypercholesterolemia, diabetes mellitus, active smoker), known CAD (stenosis ≥ 50%), aspirin use in the past 7 days, recent (≤ 24 hours) severe angina, elevated cardiac markers, and ST deviation ≥ 0.5 mm. The last 2 of these factors are the strongest predictors of adverse events. A low TIMI risk score, 0‐2, is associated with an 8%‐13% risk of an adverse outcome within 30 days. The TIMI risk score may need to be modified to improve its sensitivity and negative predictive value (NPV) before it can be used to help with accurate and safe ED triage and disposition.
We modified the TIMI score by replacing “increased cardiac markers” with “nondiagnostic troponin I” and “ST deviation ≥ 0.5 mm” with “nontransient ST deviation ≥ 0.5 mm.” We prospectively applied the modified TIMI (mTIMI) score to 82 consecutive patients presenting to the ED with chest pain. Inclusion criteria were age > 20 years, chest pain as chief complaint, available data for TIMI scoring, and available results of noninvasive and/or invasive cardiac testing and intervention. Exclusion criteria were acute myocardial infarction (AMI), noninvasive testing or revascularization in the previous 30 days, and elective admission. The patients were divided into 2 groups. In low‐risk group 1 were patients with a 0‐2 mTIMI score without high‐risk features as defined by the American College of Cardiology. In high‐risk group 2 were patients with a 3‐7 mTIMI score and/or high‐risk features. All patients underwent noninvasive and/or invasive cardiac testing at the discretion of the admitting physicians. Group 1 patients were either discharged for an outpatient treadmill stress test (TST) within 72 hours or admitted for a chemical stress test if they did not meet treadmill criteria. The main outcome was the composite death, AMI, and revascularization during the evaluation period.
A total of 82 patients were evaluated. There were 37 patients (45%) in group 1 and 45 patients (55%) in group 2. From group 1, 7 patients (19%) were discharged for outpatient TST; the remaining 30 patients (81%) were admitted. None of the patients in either group died or had an AMI. Fourteen patients (31%) from group 2 versus no patients from group 1 required revascularization (P < .0001). Overall, the mTIMI risk score had a sensitivity of 100% and an NPV of 100% for predicting adverse outcomes.
Among ED patients with chest pain, the mTIMI risk score accurately identifies low‐risk patients who can be safely discharged home with a plan of follow‐up for noninvasive cardiac testing within 72 hours. A larger confirming study is warranted.
L. Tibaldi, None; J. Brookhyser, None; H. Ly, None.
To cite this abstract:Tibaldi L, Brookhyser J, Ly H. Modified TIMI Risk Score Accurately Identifies Low‐Risk Patients Presenting to an Emergency Department with Chest Pain: Implication for Safe Discharge for Outpatient Noninvasive Cardiac Testing. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 67. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/modified-timi-risk-score-accurately-identifies-lowrisk-patients-presenting-to-an-emergency-department-with-chest-pain-implication-for-safe-discharge-for-outpatient-noninvasive-cardiac-testin/. Accessed July 17, 2019.