Study of in-hospital outcome in acute myocardial infarction in correlation with thrombolysis in myocardial infarction risk score

Pravin Shingade, Vinay Meshram, Umesh Madavi


Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score is purportedly an integral score for mortality risk prediction in fibrinolysis-eligible patients with STEMI. Attempt was made to evaluate the same by correlating risk stratification by TIMI score with hospital outcome of such patients.

Methods: There were 145 cases of STEMI were studied and TIMI risk scores were calculated and analysed vis-à-vis various relevant parameters. The patients were divided into three risk groups: ‘low-risk’, ‘moderate-risk’ and ‘high-risk’ based on their TIMI scores. All patients received routine anti-ischemic therapy and were thrombolysed subsequently, monitored in ICCU and followed during hospital stay for occurrence of post-MI complications.

Results: There were 79 patients (54.5%) belonged to low-risk group, 48 (33.1%) to moderate-risk group and 18 (12.4%) to high-risk group according to TIMI risk score. The mortality (total 17 deaths) was observed to be highest in the high-risk group (55.6%), followed by moderate-risk (12.2%) and low-risk group (1.28%) respectively. Out of the 7 potentially suspect variables studied, Killips classification grade 2-4 had the highest relative risk (RR-15.85), followed by systolic BP <100mmHg (RR- 10.48), diabetes mellitus (RR- 2.79) and age >65 years (RR- 2.59).

Conclusions: The TIMI risk scoring system seems to be one simple, valid and practical bed side tool in quantitative risk stratification and short-term prognosis prediction in patients with STEMI.


AMI, In-hospital outcome, Myocardial infarction, TIMI score, STEMI

Full Text:



Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 15;380(9859):2095-128.

Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297:286-94.

Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371:1435-42.

Institute of Health Metrics and Evaluation. GBD Compare 2010, Available at: Accessed on December 10, 2019.

Third International Study of Infarct Survival (ISIS-3) Collaborative Group. ISIS-3: A randomized comparison of streptokinase vs. tissue plasminogen activators vs. Anistreplase and of Aspirin plus heparin vs. Aspirin alone among 41299 cases of suspected myocardial infarction. Lancet. 1993;329:753-70.

Lee KL. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Circulation. 1995;91:1659-68.

Garcia-Almagro FJ, Gimeno JR, Villegas M. Prognostic value of the Thrombolysis in Myocardial Infarction (TIMI) risk score in an unselected population with chest pain. Construction of a new predictive model. Am J Emerg Med. 2008;26:439-45.

Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on practice guidelines (committee to revise the 1999 guidelines on the management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44:671-719.

Granger CB, Goldberg RJ, Dabbous O. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163:2345-53.

Jacqueline L, Pareira N. TIMI risk score for acute myocardial infarction according to prognostic stratification. Arq Bras Cardiol. 2009;93(2):100-6.

Hector Gonzales-Pacheo. The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty. Arch Cardiol Mex. 2012;82(1):7-13.

Morrow DA, Antman EM, Charlesworth A. TIMI risk score for ST elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation. Circulation. 2000;102:2013-7.

Berg J, Bjorg L, Dudas K. Symptoms of first myocardial infarction in women and men. Gender Med. 2009;6(3):454-62.

Zucker D, Griffith J, Beshansky J. Presentation of acute myocardial infarction in men and women. J Gen Intern Med. 1997;12(2):79-87.

Zornoff L, Paiva SA, Assalin VM. Myocardial infarction patients in the 1990s: their risk factors, stratification and survival in Canada: The Canadian Assessment of Myocardial Infarction (CAMI) Study. J am Coll Cardiol. 1996;27:1119-27.

Masood A, Quazi S. In-house outcome of acute myocardial infarction in correlation with ‘Thrombolysis in Myocardial Infarction’ risk score. J Ayub Med Coll, Abottabad. 2009;21(4):23-8.

Lee K, Woolife L, Topol E. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction- Results from an international trial of 41021 patients. Circulation. 1995;91:1659-68.

Molander L, Lovheim H, Norman T. Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. Circulation. 2008;10:1853-9.