ST elevation myocardial infarction risk stratification and prognosis

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Risk calculators and risk factors for ST elevation myocardial infarction risk stratification and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Two main risk-stratification scores are used when assessing a patient with ST elevation MI and acute coronary syndromes; the TIMI Risk Score (for MI), and the GRACE risk score (for acute coronary syndrome.

Risk Stratification in a Patient with ST Elevation MI

• The Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI:
  • The TIMI risk score for STEMI was created from simple arithmetic sum of independent predictors of mortality weighted according to the adjusted odds ratios from logistic regression analysis.
  • The patient pool (n=14114) came from the Intravenous nPA for Treatment of Infarcting Myocardium Early II trial (TIME II).
  • The TIMI risk score was subsequently validated in an unselected heterogeneous community population through the National Registry of Myocardial Infarction (NRMI) 3 & 4.
• The Global Registry of Acute Coronary Events (GRACE) risk score for ACS:
  • The GRACE risk score was created from a multivariable logistic regression model using ACS patients enrolled in the GRACE registry (N=11389).
  • The GRACE risk score was validated using subsequent cohort of patients enrolled in GRACE (n=3972) and the Global Use of Strategies to Open Occluded Coronary Arteries IIb (GUSTO-IIb) trial (n=12142).
• The latest AHA/ACCA Guidelines for Unstable Angina/Non -ST-Elevation Myocardial Infarction also provide guidelines for risk stratification for ACS.