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Improved in-hospital outcomes in acute coronary syndromes (unstable angina/non-ST segment elevation myocardial infarction) despite similar TIMI risk scores.
J Invasive Cardiol 2003; 15(9):502-6JI

Abstract

BACKGROUND

The Thrombolysis In Myocardial Infarction (TIMI) Risk Score has been shown to predict prognosis in acute coronary syndromes (ACS) comprised of unstable angina (UA) and non-ST segment elevation myocardial infarction (STEMI). We sought to evaluate the impact of newer antiplatelet and antithrombotic therapies for ACS, such as glycoprotein IIb/IIIa inhibitors (GPI) and low molecular weight heparin (LMWH), on in-hospital outcomes over time in patients (pts) with similar TIMI risk scores.

METHODS

The baseline demographics and clinical outcomes of pts with ACS (UA and non-STEMI) in 1998 (Group 1998) and 2000 (Group 2000) at a single large university medical center were compared using a prospectively collected database. In-hospital major adverse cardiac events (MACE) included death, MI, or recurrent angina that resulted in urgent revascularization. Risk was estimated by utilizing the TIMI Risk Score, which uses 7 predictor variables: age > 65 years, at least 3 risk factors for coronary artery disease, prior coronary stenosis of 50%, ST segment deviation on EKG, severe angina, prior aspirin use, and elevated cardiac biomarkers.

RESULTS

Comparing Group 1998 (n = 563) and Group 2000 (n = 604), there was no difference between the mean TIMI Risk Score (2.90 1.52 vs. 2.91 1.52; p = 0.97), demonstrating a similar risk profile. Nevertheless, significant improvement in in-hospital MACE (9.1% vs. 2.8%; p < 0.001) was noted. The improvement in MACE was due to differences in rates of recurrent angina, without significant differences in death and myocardial infarction. This occurred temporally in association with a significant increase in GPI (1.0% vs. 8.3%; p < 0.01) and LMWH (0.0% vs. 15.6%; p < 0.001) use within 24 hours of presentation, and the increased utilization of intracoronary stenting (46.6% vs. 64.6%; p = 0.005), findings which were confirmed with multivariate analysis.

CONCLUSION

Despite similar TIMI Risk Scores, the in-hospital outcomes of pts with ACS have improved over time. This temporal change is associated with the greater use of newer antiplatelet and antithrombotic therapies and increased utilization of intracoronary stenting.

Authors+Show Affiliations

Rush-Presbyterian-St. Luke's Medical Center, Rush Heart Institute, Chicago, IL, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12947210

Citation

Almeda, Francis Q., et al. "Improved In-hospital Outcomes in Acute Coronary Syndromes (unstable angina/non-ST Segment Elevation Myocardial Infarction) Despite Similar TIMI Risk Scores." The Journal of Invasive Cardiology, vol. 15, no. 9, 2003, pp. 502-6.
Almeda FQ, Hendel RC, Nathan S, et al. Improved in-hospital outcomes in acute coronary syndromes (unstable angina/non-ST segment elevation myocardial infarction) despite similar TIMI risk scores. J Invasive Cardiol. 2003;15(9):502-6.
Almeda, F. Q., Hendel, R. C., Nathan, S., Meyer, P. M., Calvin, J. E., & Klein, L. W. (2003). Improved in-hospital outcomes in acute coronary syndromes (unstable angina/non-ST segment elevation myocardial infarction) despite similar TIMI risk scores. The Journal of Invasive Cardiology, 15(9), pp. 502-6.
Almeda FQ, et al. Improved In-hospital Outcomes in Acute Coronary Syndromes (unstable angina/non-ST Segment Elevation Myocardial Infarction) Despite Similar TIMI Risk Scores. J Invasive Cardiol. 2003;15(9):502-6. PubMed PMID: 12947210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved in-hospital outcomes in acute coronary syndromes (unstable angina/non-ST segment elevation myocardial infarction) despite similar TIMI risk scores. AU - Almeda,Francis Q, AU - Hendel,Robert C, AU - Nathan,Sandeep, AU - Meyer,Peter M, AU - Calvin,James E, AU - Klein,Lloyd W, PY - 2003/8/30/pubmed PY - 2003/11/8/medline PY - 2003/8/30/entrez SP - 502 EP - 6 JF - The Journal of invasive cardiology JO - J Invasive Cardiol VL - 15 IS - 9 N2 - BACKGROUND: The Thrombolysis In Myocardial Infarction (TIMI) Risk Score has been shown to predict prognosis in acute coronary syndromes (ACS) comprised of unstable angina (UA) and non-ST segment elevation myocardial infarction (STEMI). We sought to evaluate the impact of newer antiplatelet and antithrombotic therapies for ACS, such as glycoprotein IIb/IIIa inhibitors (GPI) and low molecular weight heparin (LMWH), on in-hospital outcomes over time in patients (pts) with similar TIMI risk scores. METHODS: The baseline demographics and clinical outcomes of pts with ACS (UA and non-STEMI) in 1998 (Group 1998) and 2000 (Group 2000) at a single large university medical center were compared using a prospectively collected database. In-hospital major adverse cardiac events (MACE) included death, MI, or recurrent angina that resulted in urgent revascularization. Risk was estimated by utilizing the TIMI Risk Score, which uses 7 predictor variables: age > 65 years, at least 3 risk factors for coronary artery disease, prior coronary stenosis of 50%, ST segment deviation on EKG, severe angina, prior aspirin use, and elevated cardiac biomarkers. RESULTS: Comparing Group 1998 (n = 563) and Group 2000 (n = 604), there was no difference between the mean TIMI Risk Score (2.90 1.52 vs. 2.91 1.52; p = 0.97), demonstrating a similar risk profile. Nevertheless, significant improvement in in-hospital MACE (9.1% vs. 2.8%; p < 0.001) was noted. The improvement in MACE was due to differences in rates of recurrent angina, without significant differences in death and myocardial infarction. This occurred temporally in association with a significant increase in GPI (1.0% vs. 8.3%; p < 0.01) and LMWH (0.0% vs. 15.6%; p < 0.001) use within 24 hours of presentation, and the increased utilization of intracoronary stenting (46.6% vs. 64.6%; p = 0.005), findings which were confirmed with multivariate analysis. CONCLUSION: Despite similar TIMI Risk Scores, the in-hospital outcomes of pts with ACS have improved over time. This temporal change is associated with the greater use of newer antiplatelet and antithrombotic therapies and increased utilization of intracoronary stenting. SN - 1042-3931 UR - https://www.unboundmedicine.com/medline/citation/12947210/Improved_in_hospital_outcomes_in_acute_coronary_syndromes__unstable_angina/non_ST_segment_elevation_myocardial_infarction__despite_similar_TIMI_risk_scores_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -