In the TIMI-11B trial, a score was developed based on risk factors and clinical presentation that distinguished those patients with UA or non-ST elevation myocardial infarction (NSTEMI) into risk categories of low (0-2), intermediate (3-4) and high (5-7). Currently there have been 23 TIMI trials that have provided insights into the pathophysiology, and clinical course and have provided information that is useful in the treatment of acute MI and UA 5. They examined thrombolytic and antithrombotic regimens in acute MI and unstable angina (UA). The TIMI score was developed by the TIMI trials that began in 1984. Multiple studies have been conducted to show potentiation effects of risk factors on a person's risk for having CAD. The traditional risk factors for CAD are advanced age, sex, family history, dyslipidemia, cigarette smoking, hypertension, diabetes, obesity, and sedentary lifestyle. However, in reality, the presence of one or more risk factors in the young (18-59) is highly sensitive for future coronary events 4. The TIMI score is based on risk factors for CAD and clinical presentation during a possible ACS 3.įor many years it was felt that approximately 50% of coronary events occurred in patients with no risk factors. One example is the Thrombolysis in Myocardial Infarction (TIMI) risk score. In many facilities a scale is used to determine the risk of an acute coronary syndrome based on risk factors.
It is the standard of care in the United States to utilize risk factor stratification to help determine the type of cardiac work-up a patient needs when presenting with chest pain. The benefits from this risk stratification are multiple, including time involved, resources utilized, and money spent. Therefore, patients would not have extended hospitalizations waiting on a stress test. It is feasible, if these patients are evaluated with risk stratification that some of them could be discharged with outpatient testing.
However, these tests are only done during the “work week” causing delays during hospital admission.
The current treatment practice at the study site involves admission for provocative testing (Stress Testing with Nuclear Imaging most often) after an acute coronary syndrome (ACS) is ruled out. It is estimated that $13 billion is spent annually in the US on hospitalizing patients with chest pain who turn out not to have a MI 2. The medicine wards at the study site, a public hospital, have noted a rise in patient census, due in part to this increase. Because of the high prevalence of the disease, public awareness has resulted in an increasing number of people who present to the emergency department for evaluation of chest pain. Coronary artery disease (CAD) is the leading cause of death of Americans with an estimated 650,000 a year experiencing a myocardial infarction (MI) 1.
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