The Prognostic Implications of TIMI Risk Scores in Jordanian Patients with Acute Coronary Syndrome. Results from the Glucometabolic Abnormalities in Acute Coronary Syndrome in Jordan (GLORY) Study

Ayman Hammoudeh, Akram Saleh, Ismail Hamam, Imad Alhaddad, Mohammad Bakri, Assem Nammas, Abdulnasser Alnaquib, Mahmoud Izraiq, Hatem Tarawneh, Ahmad Harassis, Ramzi Tabbalat, Yousef Khader, Eyas Al-Mousa

Abstract


Background and Aims: Western studies have shown that TIMI (Thrombolysis In Myocardial Infarction) risk scores predict adverse events in patients with non ST-elevation acute coronary syndrome (NSTEACS) and ST-elevation myocardial infarction (STEMI). Whether this also applies to Jordanian patients is largely unknown.

Materials and Methods: We prospectively followed up 656 patients with ACS for total mortality, combined events of death, nonfatal MI or urgent coronary revascularization up to one year after admission.

Results: Of the whole group, 472 patients (72%) had NSTEACS, and 184 patients (28%) had STEMI. Among NSTEACS patients, 31.0% had a low risk score (total points 0 - 2 of 7), 43.5% had an intermediate risk score (total points 3 - 4), and 25.5% had a high risk score (total points 5 - 7). In-hospital mortality was not different in the respective risk score groups (1.4%, 0.5%, and 3.4%, p = 0.123). At 1 year, mortality was significantly higher in the high risk score group (12.8%) compared with the intermediate (4%) and low (1.4%) risk groups (p = 0.001). Among STEMI patients, 58.6% had a low risk score (total points 0 - 3 of 13 - 14), 31.0% had a low intermediate risk score (total points 4 - 6), 8.0% had a high intermediate score (total points 7 - 9), and 2.4% had a high risk score (total points > 10). In-hospital mortality rate was significantly higher in the two intermediate risk score groups (7.4%, 14.3%, respectively) and the high risk score group (50%) compared with the low risk score group (1.0%, p = 0.001). The high risk and the two intermediate risk groups also had higher one-year mortality (75%, 28.6% and 16.7%, respectively) than the low risk group (3.9%, p = 0.001). Similarly, composite events occurred at a significantly higher rate in patients with high risk scores than intermediate or low risk scores among NSTEACS and STEMI patients.

Conclusions: In Jordanian ACS patients, high TIMI risk scores were associated with a high risk of cardiovascular events. Such patients are candidates for early aggressive therapeutic strategies.

Keywords


Acute coronary syndrome, TIMI risk score, Jordanian patients.

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