Validity of TIMI Risk Score and HEART Score for Risk Assessment of Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction Presented to an Emergency Department in Jordan

Abstract

Purpose

To examine the validity and predictability of thrombolysis in myocardial infarction (TIMI) risk and HEART scores in patients presenting to the emergency department (ED) with chest pain in Jordan (representative of the Middle East and North Africa Region, MENA).

Patients and Methods

Risk scores were calculated for 237 patients presenting to the ED with chest pain. Patients were followed-up prospectively for the need for percutaneous coronary intervention, major adverse cardiovascular events, and all-cause mortality, looking for correlation and accuracy between the predicted cardiovascular risk from TIMI risk score and HEART score and the clinical outcome.

Results

Of the 237 patients, approximately 77% were diagnosed with unstable angina and 23% diagnosed with non-ST elevation myocardial infarction (NSTEMI). about two thirds of the study population were smokers and known to have hypertension and dyslipidaemia. In 50 patients, the primary outcome (need for percutaneous coronary intervention (PCI) and/or major adverse cardiovascular events (MACE) at days 14 and 40, all-cause mortality) was observed. Regarding the predictability of the TIMI score, a larger number of events were observed in the study population than predicted. Patients with TIMI scores of 3 to 5 have about a 5–8% higher event rate than predicted.

Conclusion

Both TIMI and HEART risk scores were able to predict an elevated risk of major cardiovascular adverse events (MACE). The overall impression was that the TIMI risk score tended to underestimate risk in the study population.

Keywords:

• acute coronary syndrome
• risk stratification
• cardiovascular diseases
• emergency department

Ethics Statement

The collection and use of patients’ data was approved by the Institutional Review Board (IRB) of Jordan University of Science and Technology (JUST) and King Abdullah University Hospital (KAUH). Written informed consent for participation was obtained before recruitment in accordance with the national legislation and the institutional requirements. We explicitly confirm that our study adheres to the principles outlined in the Declaration of Helsinki.

Disclosure

All authors declare that they have no conflicts of interest.