• Zehra Jaffery, Michael P Hudson, Gordon Jacobsen, Richard Nowak, and James McCord.
• Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA. zjaffer1@hfhs.org
• J. Thromb. Thrombolysis. 2007 Oct 1;24(2):137-44.

ObjectiveTo assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS).BackgroundThe ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain.MethodsWe investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization).ResultsThere were 151 (16%) patients diagnosed with ACS. At 30 days there were 48 (5%) deaths, 84 (9%) myocardial infarctions, and 49 (5%) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 +/- 1.3 vs. 1.7 +/- 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age > or = 65 years, ST segment deviation > or = 0.5 mm elevated troponin I, and coronary stenosis > or = 50%) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score.ConclusionA modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.

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