As in the InTIME-II substudy in which the TRI was developed, patients with complete data and a heart rate between 50 and 150 beats per minute were included in our analysis (n=3153). At time of fibrinolysis, patients were randomized into one of two treatment strategies: (1) invasive strategy with routine coronary angiography performed 18 to 48 hours after fibrinolysis and revascularization with angioplasty or bypass grafting, as appropriate or (2) the conservative strategy in which angiography was performed only when there was evidence of spontaneous or exercise nuclear stress test-induced myocardial ischemia. At the time of the study, PTCA consisted of balloon angioplasty.Ī total of 3339 patients who were treated with tPA, heparin, and aspirin. Exclusion criteria were notable for patients with history of cerebrovascular disease, prior percutaneous transluminal coronary angioplasty (PTCA) within the preceding 6 months, coronary artery bypass surgery, left bundle branch block, dilated cardiomyopathy, or other serious illness (such as cancer or renal or hepatic disorder). 4 Briefly, men and women <76 years of age with ischemic chest pain lasting ≥ 30 min, with at least 1-mV ST-segment elevation in two contiguous electrocardiogram leads presenting within 4 hours of symptom onset within were treated with tPA and randomized to an invasive versus conservative treatment strategy. 4 – 6 With median 3 years follow-up in the TIMI-II trial, we aimed to determine whether the TRI is predictive of long-term mortality and of recurrent myocardial infarction (MI), and/or congestive heart failure (CHF).ĭetails of the TIMI-II trial have been previously reported. The TIMI-II clinical trial was a multi-center randomized control trial in which 3339 patients with STEMI were initially treated with intravenous tissue-type plasminogen activator (tPA) and then randomized to either an invasive or conservative strategy. 2 In a single center cohort study of 710 unselected patients with acute coronary syndrome (ACS), the TRI was found to be predictive of long-term mortality (median 9.6 years) with a c statistic of 0.70 in patients with STEMI, but there were only 116 patients in the STEMI subgroup. 1 Furthermore, the TRI was found to have even better discriminatory capacity (c statistic 0.81) for predicting in-hospital mortality when validated in the general population of STEMI patients treated with reperfusion therapy, including fibrinolytic or primary percutaneous coronary intervention (PCI). The TRI was originally developed in the Intravenous NPA for the Treatment of Infarction Myocardium Early (InTIME-II) study and validated in the TIMI 9 trial with high prognostic discriminatory capacity (c statistic 0.79) as a tool to triage STEMI patients. 1 The TRI is a continuous index derived from three readily available clinical variables and is calculated using the equation: (heart rate × 2/systolic blood pressure). The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for ST-Elevation Myocardial Infarction (STEMI) is a simple risk score designed to be used at initial presentation to predict 30-day mortality in STEMI patients treated with fibrinolytics.
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