TIMI Score Modification for Predicting 30-Day Mortality Following Primary Percutaneous Coronary Intervention among STEMI Patients at Cipto Mangunkusumo National Hospital
Keywords:
ST Elevation Myocardial Infarction, Percutaneous Coronary Intervention, hospital mortality, risk assessment, prognosis, IndonesiaAbstract
Background: This study to validate the TIMI (Thrombolysis in Myocardial Infarction) core and also assess the validity of a modified TIMI score that includes three additional variables from primary percutaneous coronary intervention (PPCI) findings: left ventricular ejection fraction based on echocardiography post-PPCI, TIMI flow, and the number of lesions in a population of STEMI (ST-elevation myocardial infarction) patients who underwent PPCI at Cipto Mangunkusumo National Hospital, with a focus on predicting 30-day mortality. This is the first study to validate the TIMI score among STEMI patients who underwent PPCI at Cipto Mangunkusumo National Hospital. This study aimed to develop a modified TIMI score with enhanced ability to predict 30-day mortality among STEMI patients at Cipto Mangunkusumo National Hospital following PPCI. Results: Among 230 study subjects, the 30-day mortality rate for the patients post-PPCI was 10%. There was no significant association between ejection fraction based on echocardiography after PPCI, TIMI flow, or the number of lesions and 30-day mortality post-PPCI in the STEMI patients. The discrimination performance of the TIMI score in predicting 30-day mortality post-PPCI was AUC (Area Under the Curve) 0.901, with good calibration. Conclusion: The performance of the TIMI score in terms of predicting 30-day mortality after PPCI in STEMI patients at Cipto Mangunkusumo National Hospital was excellent (AUC 0.901, 95% CI 0.849–0.952), with good calibration. TIMI score can predict the 30-day mortality rate among STEMI patients undergoing PPCI.References
Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016;4(13):256. doi:10.21037/atm.2016.06.33
Mrdovic I, Savic L, Perunicic J, et al. Development and validation of a risk scoring model to predict net adverse cardiovascular outcomes after primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: rationale and design of the RISK‐PCI study. J Interv Cardiol. 2009;22(4):320-8. doi:10.1111/j.1540-8183.2009.00476.x
Savic L, Mrdovic I, Asanin M, Stankovic S, Krljanac G, Lasica R. Using the RISK-PCI score in the long-term prediction of major adverse cardiovascular events and mortality after primary percutaneous coronary intervention. J Interv Cardiol. 2019;2019:1-9. doi:10.1155/2019/2679791
Song J, Liu Y, Wang W, et al. A nomogram predicting 30-day mortality in patients undergoing percutaneous coronary intervention. Front Cardiovasc Med. 2022;9. doi:10.3389/fcvm.2022.897020
Thrane PG, Olesen KKW, Thim T, et al. Mortality trends after primary percutaneous coronary intervention for st-segment elevation myocardial infarction. J Am Coll Cardiol. 2023;82(10):999-1010. doi:10.1016/j.jacc.2023.06.025
Pedersen F, Butrymovich V, Kelbæk H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol. 2014;64(20):2101-2108. doi:10.1016/j.jacc.2014.08.037
Morrow DA. Application of the TIMI risk score for ST-elevation MI in the National Registry of myocardial infarction 3. JAMA. 2001;286(11):1356. doi:10.1001/jama.286.11.1356
Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-Elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation. Circulation. 2000;102(17):2031-7. doi:10.1161/01.CIR.102.17.2031
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-826. doi:10.1093/eurheartj/ehad191
Hess EP, Agarwal D, Chandra S, et al. Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis. Can Med Assoc J. 2010;182(10):1039-44. doi:10.1503/cmaj.092119
Sia CH, Zheng H, Ko J, et al. Comparison of the modified Singapore myocardial infarction registry risk score with GRACE 2.0 in predicting 1-year acute myocardial infarction outcomes. Sci Rep. 2022;12(1):14270. doi:10.1038/s41598-022-16523-6
Khan R, Zarak MS, Munir U, Ahmed K, Ullah A. Thrombolysis in myocardial infarction (TIMI) risk score assessment for complications in acute anterior wall ST elevation myocardial infarction. Cureus. Published online June 15, 2020. doi:10.7759/cureus.8646
Setyawan M, Antono D, Dewiasty A. Validasi Skor thrombolysis in myocardial infarction (TIMI) dalam memprediksi mortalitas pasien sindrom koroner akut di Indonesia. Universitas Indonesia; 2011.
Muhadi, Alwi I, Antono D. Karakteristik sindrom koroner akut dengan edema paru kardiogenik di ICCU RS Cipto Mangunkusumo dan faktor-faktor yang berhubungan. Universitas Indonesia; 2009.
Mansur T. Modifikasi Skor TIMI sebagai model prediksi mortalitas 30 hari pasien STEMI muda. Jurnal Penyakit Dalam Indonesia. 2023;10(4). doi:10.7454/jpdi.v10i4.1489
Kusunose K, Zheng R, Yamada H, Sata M. How to standardize the measurement of left ventricular ejection fraction. Journal of Medical Ultrasonics. 2022;49(1):35-43. doi:10.1007/s10396-021-01116-z
Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure. J Card Fail. 2021;27(4):387-413. doi:10.1016/j.cardfail.2021.01.022
Liu Y, Song J, Wang W, et al. Association of ejection fraction with mortality and cardiovascular events in patients with coronary artery disease. ESC Heart Fail. 2022;9(5):3461-8. doi:10.1002/ehf2.14063
Left Ventricular Ejection Fraction - StatPearls - NCBI Bookshelf. Accessed August 24, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459131/
Chew DS, Heikki H, Schmidt G, et al. Change in left ventricular ejection fraction following first myocardial infarction and outcome. JACC Clin Electrophysiol. 2018;4(5):672-82. doi:10.1016/j.jacep.2017.12.015
Ye Z, Lu H, Li L. Reduced left ventricular ejection fraction is a risk factor for in-hospital mortality in patients after percutaneous coronary intervention: A hospital-based survey. Biomed Res Int. 2018;2018:1-8. doi:10.1155/2018/8753176
Hendrickson MJ, Arora S, Vaduganathan M, et al. Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India. ESC Heart Fail. 2022;9(6):3836-45. doi:10.1002/ehf2.14055
Ndrepepa G, Cassese S, Byrne RA, et al. Left ventricular ejection fraction change following percutaneous coronary intervention: Correlates and association with prognosis. J Am Heart Assoc. Published online October 18, 2024. doi:10.1161/JAHA.124.035791
Mehta RH, Ou FS, Peterson ED, et al. Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2009;2(1):56-64. doi:10.1016/j.jcin.2008.10.006
Mandal SC, Shah B, Rekwal L, Batra V. Predicting 30-day mortality using ST-segment elevation resolution in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: an indian scenario. Cureus. Published online May 7, 2023. doi:10.7759/cureus.38663
Bailleul C, Aissaoui N, Cayla G, et al. Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction: Results from the FAST-MI 2010 registry. Arch Cardiovasc Dis. 2018;111(2):101-8. doi:10.1016/j.acvd.2017.04.004
Li YX, Wang BN, Fan FF, et al. Thirty-day outcomes of in-hospital multi-vessel versus culprit-only revascularization strategy for st-segment elevation myocardial infarction with multivessel coronary disease. Journal of Geriatric Cardiology. 2023;20(7):485-94. doi:10.26599/1671-5411.2023.07.005
Lee JH, Park HS, Ryu HM, et al. Impact of multivessel coronary disease with chronic total occlusion on one-year mortality in patients with acute myocardial infarction. Korean Circ J. 2012;42(2):95. doi:10.4070/kcj.2012.42.2.95
Hadanny A, Shouval R, Wu J, et al. Predicting 30-day mortality after ST elevation myocardial infarction: Machine learning- based random forest and its external validation using two independent nationwide datasets. J Cardiol. 2021;78(5):439-46. doi:10.1016/j.jjcc.2021.06.002
Reindl M, Holzknecht M, Tiller C, et al. Impact of infarct location and size on clinical outcome after ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol. 2020;301:14-20. doi:10.1016/j.ijcard.2019.11.123
Kim EK, Choi JH, Song Y Bin, et al. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction. Am Heart J. 2016;171(1):56-63. doi:10.1016/j.ahj.2015.10.016
Wang KY, Zheng YY, Wu TT, Ma YT, Xie X. Predictive value of gensini score in the long-term outcomes of patients with coronary artery disease who underwent PCI. Front Cardiovasc Med. 2022;8. doi:10.3389/fcvm.2021.778615
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-27.
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