A Novel Risk Stratification Model for Patients with Non-ST Elevation Myocardial Infarction in the Korea Acute Myocardial Infarction Registry (KAMIR): Limitation of the TIMI Risk Scoring System
- A Novel Risk Stratification Model for Patients with Non-ST Elevation Myocardial Infarction in the Korea Acute Myocardial Infarction Registry (KAMIR): Limitation of the TIMI Risk Scoring System
- 김영조; 김주한[김주한]; 정명호[정명호]; 안영건[안영건]; 채성철[채성철]; 성인환[성인환]; 김종진[김종진]; 조명찬[조명찬]; 박성중[박성중]; 성기백[성기백]
- Angina; unstable; Mortality; Myocardial Infarction
- Issue Date
- 전남대학교 의과학연구소
- 전남의대학술지, v.47, no.1, pp.20 - 26
- The Thrombolysis in Myocardial Infarction (TIMI) risk score (TRS) has proven value in predicting prognosis in unstable angina/non ST-elevation myocardial infarction (NSTEMI) as well as in ST-elevation myocardial infarction. The TRS system has little implication, however, in the extent of myocardial damage in high-risk patients with NSTEMI. A total of 1621 patients (63.6±12.2 years; 1043 males) with NSTEMI were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR). We analyzed the risk for major adverse cardiac events (MACE) during a 6-month follow-up period. The TRS system showed good correlation with MACE for patients in the low and intermediate groups but had poor correlation when the high-risk group was included (p=0.128). The MACE rate was 3.8% for TRS 1, 9.4% for TRS 2, 10.7% for TRS 3, and 12.3% for TRS 4 (HR=1.29, p=0.026). Among the biomarkers and clinical risk factors,elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) (HR=2.61, p=0.001)and Killip class above III showed good correlation with MACE (HR=0.302, p＜0.001).
Therefore, we revised an alternative clinical scoring system by including these two variables that reflect left ventricular dysfunction: age ＞ 65 years, history of ischemic heart disease, Killip class above III, and elevated pro-BNP levels above the 75th percentile.
This modified scoring system, when tested for validity, showed good predictive value for MACE (HR=1.64, p＜0.001). Compared with the traditional TRS, the novel alternative scoring system based on age, history of ischemic heart disease, Killip class, and NT-proBNP showed a better predictive value for 6-month MACE in high-risk patients with NSTEMI.
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