Objectives:
Patients presenting with chest pain or related symptoms suggestive of myocardial ischemia, without ST‐segment elevation (NSTE) on their presenting electrocardiograms, often present a ...diagnostic challenge in the emergency department (ED). Prompt and accurate risk stratification to identify those patients with NSTE chest pain who are at highest risk for adverse events is essential, however, to optimal management. Although validated and used frequently in patients already enrolled in acute coronary syndrome trials, the Thrombolysis in Myocardial Infarction (TIMI) risk score never has been examined for its value in risk stratification in an all‐comers, non–trial‐based ED chest pain population.
Methods:
An analysis of an ED‐based prospective observational cohort study was conducted in 3,929 adult patients presenting with chest pain syndrome and warranting evaluation with an electrocardiogram. These patients had TIMI risk scores determined at ED presentation. The main outcome was the composite of death, acute myocardial infarction (MI), and revascularization within 30 days.
Results:
The TIMI risk score at ED presentation successfully risk‐stratified this unselected cohort of chest pain patients with respect to 30‐day adverse outcome, with a range from 2.1%, with a score of 0, to 100%, with a score of 7. The highest correlation of an individual TIMI risk indicator to adverse outcome was for elevated cardiac biomarker at admission. Overall, the score had similar performance characteristics to that seen when applied to other databases of patients enrolled in clinical trials and registries using a 14‐day end point.
Conclusions:
The TIMI risk score may be a useful tool for risk stratification of ED patients with chest pain syndrome.
The MAPH (mean platelet volume, age, total protein and hematocrit) score is a newly developed simple scoring system for patients with STEMI that has been associated with satisfactory predictive ...values to determine thrombus burden in STEMI patients. Therefore, the aim of our study was to determine the relationship between the MAPH risk score and TIMI flow in patients with STEMI.The study included 260 patients who underwent primary percutaneous coronary intervention between December 2019 to July 2022, and had TIMI 0 flow in the responsible coronary artery due to STEMI. According to the TIMI flow score after stent implantation, the patients were classified into either the no-reflow group (n = 59) or the normal flow group (n = 201). In order to calculate the MAPH score, ROC analysis was performed to find the cutoff point for each component of the MAPH score. MAPH scores were calculated (MPV + Age + Protein + Hematocrit) for both groups. Our study was a retrospective, observational study.In the multivariable regression analysis, the MAPH score (OR: 0.567; 95%CI: 0.330-0.973, P = 0.04) and glycoprotein IIb/IIIa inhibitors (OR: 0.249; 95%CI: 0.129-0.483, P < 0.001) were parameters found to be independent predictors of TIMI flow. An MAPH score value > 2.5 predicted the presence of low TIMI coronary flow in patients with STEMI, with 78% specificity and 45% sensitivity (ROC area under curve: 0.691, 95% CI: 0.617-0.766, P < 0.001).The MAPH risk score is simple, inexpensive, and quick to calculate. A high MAPH score may be an indicator of coronary no-reflow in patients with STEMI.
Background: Accurate risk stratification in patient clinically presented as a case of Non-ST Elevation acute coronary syndrome (NSTE-ACS) is important to assess the prognosis as well as to estimate ...the possible adverse event especially in those patient who are at high risk. Of these scoring risk; Thrombolysis In Myocardial Infarction (TIMI) risk score have been well corroborated to predict the possible prognosis for patients with NSTE-ACS. However, their value in estimation the severity of coronary artery disease (CAD) has been less studied. Objective: To determine the role of TIMI score in prediction the severity of CAD and its extent by correlate the TIMI score with coronary angiography in patients have NSTE-ACS. Patients and Methods: A cross section study, conducted on 264 successive patients admitted with Non-ST Elevation acute coronary syndrome at Ibn-Albitar cardiac center, Baghdad, Iraq, from the 1st of October 2017 to the 1st of October 2018. Patients were rearranging into three groups according to the seven standard variables of TIMI score. The extent of CAD was examined on coronary angiography; a lesion defined significant if stenosis ≥70% in any artery of three major coronary arteries or ≥50% of left main coronary artery. Results: The total number of was 246 patients, mean age was 62.5±2.3 years. There were 67 (27.2%) of them belong to group 1 (low risk group), 142 (57.7%) of them belong to group 2 (intermediate risk group), and 37 (15.1%) of them belong to group 3 (high risk group). 54.1% of patients in group 3 had significant three-vessels coronary artery disease on comparing with 17.6% of group 2 patients and only 7.5% of group 1 patients had these lesions on coronary angiography (P-value <0.01). On the other hand, one-vessel coronary artery disease occurs more commonly and significant statistically (P-value <0.01) in group 2 (31.7%) than in patients in group 1 (26.9%) and group 3 (10.8%). Conclusion: High TIMI risk score patients were more probably to have significant multi-vessels coronary lesions in comparison with those with TIMI risk score in intermediate or low range which lead to help in stratify the risk and possibility of early intervention.
Objectives The PLATO (Platelet Inhibition and Patient Outcomes) angiographic substudy sought to compare the efficacy of ticagrelor versus clopidogrel with respect to angiographic outcomes before and ...after PCI in the setting of acute coronary syndrome. Background Greater platelet inhibition has been associated with improved angiographic outcomes before and after percutaneous coronary intervention (PCI). Therefore, it was hypothesized that treatment with ticagrelor, which achieves more rapid, higher, and more consistent platelet inhibition, would be associated with improved angiographic outcomes when compared with those of clopidogrel treatment. Methods The angiographic cohort consists of 2,616 patients drawn from the 18,624-patient PLATO trial. Clopidogrel naïve or pre-treated patients were randomized to 180 mg of ticagrelor or 300 mg of clopidogrel (75 mg for clopidogrel pre-treated patients). PCI patients were administered, as per treatment group: 1) an additional 90 mg of ticagrelor if >24 h following the initial loading dose; or 2) an optional further 300 mg of clopidogrel or placebo (total 600 mg) prior to PCI. The substudy primary endpoint was the incidence of post-PCI TIMI (Thrombolysis In Myocardial Infarction) myocardial perfusion grade 3 (TMPG 3) among patients who received a study drug prior to PCI. Results In total, 21.3% of patients were pretreated with clopidogrel prior to randomization. There was a short time interval between randomization and PCI (median: 0.68 interquartile range (IQR): 0.30 to 2.21 h) among all patients. Post-PCI TMPG 3 was similar between the ticagrelor and clopidogrel groups (47.1% vs. 46.9%; p = 0.96). Likewise, the following pre-PCI outcomes were similar in the ticagrelor and clopidogrel groups, respectively: TMPG 3 (30.5% vs. 31.2%), TIMI flow grade 3 (37.1% vs. 39.3%), corrected TIMI frame count (median: 100 vs. 71 frames), TIMI thrombus grade 0 (24.1% vs. 27.6%), minimum lumen diameter (median: 0.3 IQR: 0.0 to 0.6 vs. 0.3 IQR: 0.0 to 0.6 mm) and percentage of diameter stenosis (median: 89 IQR: 78 to 100 vs. 89 IQR: 77 to 100). Conclusions Neither coronary flow nor myocardial perfusion, evaluated on coronary angiograms performed before or following PCI procedures within a few hours after the start of oral antiplatelet treatment in the setting of acute coronary syndromes, demonstrated a difference with ticagrelor versus clopidogrel. (A Comparison of Ticagrelor AZD6140 and Clopidogrel in Patients With Acute Coronary Syndrome PLATO; NCT00391872 )
The Mankarchua Quartzite is a 300 m thick arenite-dominated succession developed on the southwestern margin of the Singhbhum craton, eastern India. Detrital zircon dates available from the succession ...suggest the age of the youngest population at 2.9 Ga. The arenite dominant succession with very low degree of deformation or metamorphic overprint preserves the depositional primary sedimentary structures and petrography for reconstruction of depositional setting and tectonic setting with considerable clarity. We classified the Mankarchua Quartzite into three members, namely, in the ascending order, the Rajabasa Member, the Timi Member and the Gurusanga Member. Facies analysis on the succession identifies eleven sedimentary facies that can be related to basin margin alluvial fan, wave-/tide-dominated lower shoreface to shelf transitional environments. The entire succession represents a lower order transgressive sequence presumably controlled by tectono-eustatic base level rise and drowning of a continental shelf. Three members can be related to higher order cycles that are likely to have resulted from local scale basin margin tectonics. Paleocurrent patterns corroborate to the alluvial fan/braided stream and wave-/tide-dominated depositional settings. The succession records transition in a narrow interval from coarse-grained conglomerate-pebbly sandstone to sandstone-siltstone-mudstone dominated facies associations in a Meso-Neoarchean drowning shelf.
Thrombolysis in Myocardial Infarction Frame Count (TFC) is an index that provides a quantitative evaluation of coronary microvascular dysfunction. In this study, we aimed to examine the effect of ...COVID-19 infection on TFC in patients admitted with chest pain and dyspnoea after COVID-19 disease and had abnormal findings in myocardial perfusion scintigraphy.
For this single-center retrospective study, patients with and without a history of COVID-19 who were underwent coronary angiography for abnormal findings in myocardial perfusion scintigraphy between January 1, 2021 and June 30, 2021 were analysed. Patients were divided into two groups as patients with COVİD-19 history and those without. After exclusion criteria, patients with adequate angiographic monitoring and data were included in the study.
A total of 210 patients, 48 with a history of COVID-19, were included in the study. The mean age was ±55 10 years, and 122 (58%) patients were women. In patients with a history of COVID-19, TFC was significantly higher in the LAD (p < 0.001) and LCx (p < 0.001) arteries and RCA TFC (p = 0.223) was similar in both groups. In the linear mix model, male gender (β = 2.38, 95% CI = 1.26-3.51, p < 0.001) and history of COVID-19 (β = 1.51, 95% CI = 0.49-2.53, p = 0.004) were significantly associated with TFC.
TFC may be elevated due to coronary microvascular dysfunction in patients with a history of COVID-19.
Introduction The efficacy of coronary artery bypass graft (CABG) surgery for patients with ischemic heart disease is dependent on the patency of the selected conduit. The left internal thoracic ...artery is considered to be the best conduit for CABG. However, the preferred conduit between the radial artery (RA) and saphenous vein (SV) remains controversial. The present meta-analysis aims to establish the current level IA evidence on patency outcomes comparing the RA and SV. Methods Electronic searches were performed using 6 databases from their inception to March 2012. Two reviewers independently identified all relevant randomized controlled trials (RCTs) comparing patency outcomes of RA and SV grafts after CABG. Data were extracted and meta-analyzed according to angiographic end points at specified follow-up intervals. Results Five relevant RCTs were identified for inclusion in the present meta-analysis. Angiographic results indicated that the RA was significantly more likely to be completely patent and less likely to be associated with graft failure or complete occlusion at 4 years' follow-up and beyond. However, the RA was significantly more likely to be associated with string sign at 1 year of follow-up. Conclusions While acknowledging the limitations of heterogeneous surgical techniques, results from the present meta-analysis suggest potential superiority of the RA compared with the SV at midterm angiographic follow-up. However, the increased incidence of string sign associated with the RA is of potential clinical concern. Further research should be directed at correlating angiographic findings of string sign and graft failure to clinical symptoms and major adverse cardiac and cerebrovascular events at long-term follow-up.
•Coronary slow flow (CSF) is commonly linked to worse cardiovascular events and life-threatening arrhythmias.•The prognostic impact of CSF on myocardial infarction with the non-obstructive coronary ...artery (MINOCA) has never been studied.•Our results demonstrated that CSF is associated with a higher risk of adverse events and is an independent predictor of clinical outcomes among patients with MINOCA.•CSF may serve as a robust tool to stratify high-risk MINOCA patients to prompt a close follow-up and improve overall survival.
Coronary slow flow (CSF) is common and linked to worse cardiovascular events and life-threatening arrhythmias. However, the clinical implication of CSF among myocardial infarction with the non-obstructive coronary artery (MINOCA) has never been studied. We aimed to evaluate the impact of CSF on the MINOCA population.
Patients diagnosed with MINOCA were consecutively selected. The corrected TIMI frame count (cTFC) was used to evaluate the coronary flow. CSF was defined as cTFC greater than 27 frames per second (FPS) in any of the three coronary arteries. Major adverse cardiovascular events (MACE) are the primary endpoint. Cox regression analysis was used to evaluate the association between CSF and MACE.
A total of 158 patients with MINOCA were enrolled, of which 54 (34.2%) patients had CSF. Forty incidents of MACE occurred during the median 28 months of follow-up. The MACE incidence was higher among patients who presented with CSF than the normal coronary flow patients (35.2% vs. 20.2%, p = 0.040). In the Kaplan-Meier analysis, CSF patients had significantly higher rates of MACE (log-rank P = 0.034). Multivariate Cox regression analysis showed that CSF was an independent predictor linked to an increased hazard of MACE (adjusted HR, 2.76; 95% CI, 1.34–5.67; P = 0.006).
The presence of CSF is associated with a higher risk of adverse events and is an independent predictor of clinical outcomes among patients with MINOCA. This result suggests that CSF might serve as a robust tool to stratify MINOCA patients.
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Thrombolysis in Myocardial Infarction (TIMI) 0 flow often characterizes ST-segment Elevation Myocardial Infarction (STEMI) patients, but may also feature in non-ST-segment Elevation Acute Coronary ...Syndrome (NSTE-ACS). Since recanalization usually occurs later in NSTE-ACS patients, the aim of this study was to assess whether patients presenting with NSTE-ACS and TIMI 0 flow have worse clinical outcomes as compared to patients presenting with STEMI and TIMI 0 flow.
A single-center retrospective cohort study was conducted with patients treated for NSTE-ACS and STEMI with TIMI 0 flow at diagnostic angiogram between January 2015 and December 2019. The two patient groups were 1:1 matched using a propensity score logistic regression model. The primary outcome was Major Adverse Cardiac Events (MACE), a composite of all-cause mortality, any myocardial infarction, coronary artery bypass graft, urgent target vessel revascularization or stroke during long term follow-up.
The total population consisted of 1255 ACS patients, of which 249 NSTE-ACS and 1006 STEMI patients. After propensity score matching, 234 NSTE-ACS patients were matched with 234 STEMI patients. In this matched population, the mean age was 62.6 (±12.4) years and 75.2 % of the patients was male. The median follow-up time was 3.2 years. MACE rates during follow-up were similar between the two matched groups (HR = 0.84 95 % CI 0.60 – 1.12 with p = 0.33) with cumulative event-free survival of 63.3 % in the NSTE-ACS group vs 59.3 % in the STEMI group at 6 year follow-up.
In this retrospective study, a culprit lesion with TIMI 0 flow has similar clinical outcome in NSTE-ACS and STEMI patients. Further research is warranted to determine optimal the timing of PCI in NSTE-ACS patients with TIMI 0 flow.
Background
The TIMI‐AF score predicts poor outcomes in patients with atrial fibrillation (AF) and guides selection of anticoagulant therapy by identifying clinical benefit of direct oral ...anticoagulants (DOACs) or vitamin K antagonists (VKA).
Hypothesis
Our objective was to determine the ability to predict cardiovascular events according to the TIMI‐AF score in a real‐world population.
Methods
Retrospective observational study of VKA‐naïve patients with AF was seen at a cardiology outpatient clinic in Spain between November 2012 and August 2014. We recorded adverse events (myocardial infarction, systemic embolism or stroke, major bleeding, and death).
Results
The study population comprised of 426 patients (50.7% men, mean age, 69 ± 14 years). The TIMI‐AF score identified 372 patients (87.3%) with a low risk, 50 patients (11.7%) with an intermediate risk, and 4 patients (0.9%) with a high risk. After a mean follow‐up of 423.4 ± 200.1 days, 37 patients (9%) experienced an adverse event. Patients with a TIMI‐AF score ≥ 7 had a poorer cardiovascular prognosis (HR, 6.1; 95%CI, 3.2‐11.7; P < 0.001). The area under the ROC curve of TIMI‐AF was 0.755 (95%CI, 0.669‐0.840; P < 0.001), which was greater than that of CHA2DS2VASc (0.641; 95%CI, 0.559‐0.724; P = 0.004), HAS‐BLED (0.666; 95%CI, 0.578‐0.755; P < 0.001), and SAMeTT2R2 (0.529; 95%CI, 0.422‐0.636; P = 0.565). Similar results were obtained in relation to the net clinical outcome (life‐threatening bleeding, disabling stroke, or all‐cause mortality).
Conclusions
The TIMI‐AF risk score can identify patients who are at greater risk of cardiovascular events and a poor net clinical outcome with a better diagnostic yield than CHA2DS2VASc, HAS‐BLED, and SAMeTT2R2.
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