Comparison of Thrombolysis in Myocardial Infarction Score and Heart Score in risk stratification of acute myocardial infarction patients, prognostic accuracy and arrhythmia incidence

Keerthana Batyala, M. V. Nagabhushana, Malli Dorasanamma


Background: To compare TIMI & HEART SCORE for their risk stratification in Acute Myocardial Infarction Patients,  prognostic accuracy and Arrhythmia incidence.

Methods: This observational study is conducted in a Tertiary care hospital over a period of 2 years from August 2017 to July 2019. A total of 100 patients presented to ER with Chest Pain are selected for study. Patients were monitored for a period of one month in ICCU.

Results: In present study out of 61 cases with TIMI score ≥5, mortality of 11.5%(7 cases, p value 0.028). Heart score more than 6  constitutes high risk group, out of which mortality was observed in 7.45% cases (p=0.48). Most of the arrhythmias (70.49%) in present study observed in patients with TIMI score ≥5 (High risk group) which is statistically significant with p value 0.002. Most of the arrhythmias in present study observed in patients with HS ≥8 which is not statistically significant with p value 0.135.

Conclusions: In present study, overall mortality rate was 7% and these patients who died constitutes to high risk group with TIMI. HEART SCORE identified more patients as low risk compared to TIMI SCORE. TIMI SCORE is a good predictor of arrhythmia incidence.


Thrombolysis in myocardial infarction score, Heart score, Risk stratification in acute myocardial infarction patients

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Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol. 2005;45(9):1397-405.

Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. TIMI risk score for ST- elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an Intravenous nPA for Treatment of Infarcting Myocardium II trial sub study. Circulation. 2000;102(17):2031-7.

Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-42.

Schmid CH, Lau J, McIntosh MW, Cappelleri JC. An empirical study of the effect of the control rate as a predictor of treatment efficacy in meta-analysis of clinical trials. Stat Med. 1998;17(17):1923-42.

Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-6.

Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Alodus S, et al. The HEART score for the assesment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardol. 2013;12(3):121-6.

Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP et al. Global Registry of Acute Coronary Events Investigators. Predictors of hospi- tal mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(19):2345-53.

Scruth EA, Cheng E, Worrall-Carter L. Risk score comparison of outcomes in patients presenting with ST-elevation myocardial infarction treated with percutaneous coronary intervention. Eur J Cardiovasc Nurs. 2013;12(4):330-6.

Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, et al. Predictors of 30-day mortality I in the era of reperfusion for acute myocardial infarc- tion. Results from an international trial of 41, 021 patients. GUSTO-I Investigators. Circulation. 1995;91(6):1659-68.

DeGeare VS1, Boura JA, Grines LL, O'Neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2001;87(9):1035-8.

Backus BE, Six AJ, Kelder JC, Mast TP, van den Akker F, Mast EG, et al. Chest pain in the emergency room; a multicenter validation of the HEART score. Crit Pathw Cardiol. 2010;9(3):164-9.

Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospec- tive multinational observation study (GRACE). BMJ. 2006;25;333(7578):1091.

Sun B, Laurie A, i*trACS investigators, Abstract 13647: Comparison of the HEART AND TIMI RISK SCORES for suspected acute coronary syndrome in the emergency department. Circulation. 2015;132:A13647.

Brady W, Souza K. The HEART SCORE: A guide to its application in the emergency department. Turk J Emerg Med. 2018;18(2):47-51.

Byrne C, Toarta C, Holt T. The HEART SCORE in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome : protocol for a systematic review and META – Analysis. 2018:7.

Chase M1, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE. Prospective validation of the Thrombolysis in myocardial infarction risk score in the emergency department chest pain population. Ann Emerg Med. 2006;48(3):252-9.