Application of thrombolysis in myocardial infarction risk index in the prediction of long‑term outcomes for patients with ST‑elevation myocardial infarction and multiple vessel disease: A single‑center prospective observational cohort study

Fan,Xuefang; Li,Mingliang; Cao,Jie; Liang,Zeming

doi:10.3892/etm.2021.10899

Application of thrombolysis in myocardial infarction risk index in the prediction of long‑term outcomes for patients with ST‑elevation myocardial infarction and multiple vessel disease: A single‑center prospective observational cohort study

Authors:
- Xuefang Fan
- Mingliang Li
- Jie Cao
- Zeming Liang
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Affiliations: Department of Cardiology, Xianyang Hospital of Yan'an University, Xianyang, Shanxi 712000, P.R. China, Ward No. 2, Department of Cardiovascular Disease, People's Hospital of Hanzhong City, Hanzhong, Shanxi 723000, P.R. China, Department of Cardiology, Affiliated Hospital of Yan'an University, Xiangyang, Shanxi 716000, P.R. China, Second Department of Cardiovascular Disease, Baoji Hospital of Traditional Chinese Medicine, Baoji, Shanxi 721000, P.R. China
Published online on: October 20, 2021 https://doi.org/10.3892/etm.2021.10899
Article Number: 1464
Copyright: © Fan et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The thrombolysis in myocardial infarction (TIMI) risk index has been indicated to be a simple and useful tool for risk stratification of patients with ST‑elevation myocardial infarction (STEMI). However, the predictive value of the TIMI risk index regarding the long‑term outcome for patients with STEMI with multiple vessel disease has remained to be determined. In the present study, a total of 369 patients diagnosed with STEMI who received emergency percutaneous coronary intervention treatment were analyzed. A five‑year follow‑up was performed to record the primary endpoint of all‑cause mortality, as well as the secondary endpoints of myocardial infarction, stroke, emergent revascularization and admission due to heart failure. A receiver operating characteristic (ROC) curve was used to determine the cut‑off value of the TIMI risk index for predicting all‑cause death, based on which the patients were divided into a high TIMI group and a low TIMI group. Kaplan‑Meier survival curves were used to compare the long‑term survival of the two groups and multivariate Cox regression analysis was used to evaluate the predictive value of the risk factors regarding primary and secondary endpoints. The ROC curve indicated that the TIMI risk index was associated with three‑year all‑cause death with a cut‑off value of 30.35 (area under curve, 0.705; P=0.001). The high TIMI group (>30.35) and low TIMI group (<30.35) exhibited a significant difference in all‑cause death (P=0.009) but not in any of the secondary endpoints (P=0.527). Multivariate Cox regression analysis demonstrated that a high TIMI risk index was an independent risk factor for all‑cause death in patients with STEMI and multiple‑vessel disease (hazard ratio=3.709, 95% CI: 1.521‑9.046, P=0.004). In conclusion, the TIMI risk index was associated with long‑term outcomes for patients with STEMI and multiple‑vessel disease and may be of value for risk prediction.

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1	Ruff CT and Braunwald E: The evolving epidemiology of acute coronary syndromes. Nat Rev Cardiol. 8:140–147. 2011.PubMed/NCBI View Article : Google Scholar
2	Lee WC, Wu BJ, Fang CY, Chen CJ, Yang CH, Yip HK, Hang CL, Wu CJ and Fang HY: Timing of staged percutaneous coronary intervention for a non-culprit lesion in patients with anterior wall ST segment elevation myocardial infarction with multiple vessel disease. Int Heart J. 57:417–423. 2016.PubMed/NCBI View Article : Google Scholar
3	Acet H, Ertas F, Bilik MZ, Aydın M, Yüksel M, Polat N, Yıldız A, Özyurtlu F, Akıl MA, Çiftçi L, et al: The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention. Ther Adv Cardiovasc Dis. 9:257–266. 2015.PubMed/NCBI View Article : Google Scholar
4	Damman P, Kampinga MA, van der Horst IC, Woudstra P, Grundeken MJ, Kuijt WJ, Harskamp RE, Nijsten MW, Zijlstra F, Tijssen JG, et al: Multiple biomarkers for the prediction of short and long-term mortality after ST-segment elevation myocardial infarction: The Amsterdam Groningen collaboration. J Thromb Thrombolysis. 36:42–46. 2013.PubMed/NCBI View Article : Google Scholar
5	He J, Li J, Wang Y, Hao P and Hua Q: Neutrophil-to-lymphocyte ratio (NLR) predicts mortality and adverse-outcomes after ST-segment elevation myocardial infarction in Chinese people. Int J Clin Exp Pathol. 7:4045–4056. 2014.PubMed/NCBI
6	Sakamoto JT, Liu N, Koh ZX, Fung NX, Heldeweg ML, Ng JC and Ong ME: Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department. Int J Cardiol. 221:759–764. 2016.PubMed/NCBI View Article : Google Scholar
7	Hammami R, Jdidi J, Mroua F, Kallel R, Hentati M, Abid L and Kammoun S: Accuracy of the TIMI and GRACE scores in predicting coronary disease in patients with non-ST-elevation acute coronary syndrome. Rev Port Cardiol. 37:41–49. 2018.PubMed/NCBI View Article : Google Scholar
8	Tarasov RS, Ganiukov VI, Shilov AA, Barbarash OL and Barbarash LS: Prognostic value of SYNTAX score for outcomes and revascularization strategy choice in ST-segment elevation myocardial infarction patients with multivessel coronary artery disease. Ter Arkh. 84:17–21. 2012.PubMed/NCBI(In Russian).
9	Bradshaw PJ, Ko DT, Newman AM, Donovan LR and Tu JV: Validation of the Thrombolysis In Myocardial Infarction (TIMI) risk index for predicting early mortality in a population-based cohort of STEMI and non-STEMI patients. Can J Cardiol. 23:51–56. 2007.PubMed/NCBI View Article : Google Scholar
10	Wiviott SD, Morrow DA, Frederick PD, Giugliano RP, Gibson CM, McCabe CH, Cannon CP, Antman EM and Braunwald E: Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and -4: A simple index that predicts mortality in ST-segment elevation myocardial infarction. J Am Coll Cardiol. 44:783–789. 2004.PubMed/NCBI View Article : Google Scholar
11	Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, et al: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 39:119–177. 2018.PubMed/NCBI View Article : Google Scholar
12	Karabag Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, Yesin M, Öterkus M, Gokdeniz T, Burak C and Tanboğa IH: Comparison of SYNTAX score II efficacy with SYNTAX score and TIMI risk score for predicting in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction. Int J Cardiovasc Imaging. 34:1165–1175. 2018.PubMed/NCBI View Article : Google Scholar
13	Jakimov T, Mrdovic I, Filipovic B, Zdravković M, Djoković A, Hinić S, Milić N and Filipović B: Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome. Croat Med J. 58:406–415. 2017.PubMed/NCBI View Article : Google Scholar
14	Morrow DA, Antman EM, Giugliano RP, Cairns R, Charlesworth A, Murphy SA, de Lemos JA, McCabe CH and Braunwald E: A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: An InTIME II substudy. Lancet. 358:1571–1575. 2001.PubMed/NCBI View Article : Google Scholar
15	Truong QA, Cannon CP, Zakai NA, Rogers IS, Giugliano RP, Wiviott SD, McCabe CH, Morrow DA and Braunwald E: Thrombolysis in myocardial Infarction (TIMI) risk index predicts long-term mortality and heart failure in patients with ST-elevation myocardial infarction in the TIMI 2 clinical trial. Am Heart J. 157:673–679.e1. 2009.PubMed/NCBI View Article : Google Scholar
16	Chen Y, Song Y, Xu JJ, Tang XF, Wang HH, Jiang P, Jiang L, Liu R, Zhao XY, Gao LJ, et al: Relationship between thrombolysis in myocardial infarction risk index and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction patients undergoing percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi. 46:874–881. 2018.PubMed/NCBI View Article : Google Scholar : (In Chinese).
17	Brkovic V, Dobric M, Beleslin B, Giga V, Vukcevic V, Stojkovic S, Stankovic G, Nedeljkovic MA, Orlic D, Tomasevic M, et al: Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiovasc Imaging. 29:1215–1228. 2013.PubMed/NCBI View Article : Google Scholar