An integrated clinical approach to predicting the benefit of tirofiban in non-ST elevation acute coronary syndromes. Application of the TIMI Risk Score for UA/NSTEMI in PRISM-PLUS

TLDR: The TIMI Risk Score is a simple clinical tool for risk assessment that may aid in the early identification of patients who should be considered for treatment with potent antiplatelet therapy.

Abstract: Aims We evaluated the TIMI Risk Score for Unstable Angina and Non-ST Elevation Myocardial Infarction for predicting clinical outcomes and the efficacy of tirofiban in non-ST elevation acute coronary syndromes. Methods and Results Developed in TIMI 11B, the risk score is calculated as the sum of seven presenting characteristics (age ≥65 years, ≥3 cardiac risk factors, documented coronary disease, recent severe angina, ST deviation ≥0·5mm, elevated cardiac markers, prior aspirin use). The risk score was validated in the PRISM-PLUS database (n=1915) and tested for interaction with the efficacy of tirofiban+heparin vs heparin alone. The risk score revealed an increasing gradient of risk for death, myocardial infarction or recurrent ischaemia at 14 days ranging from 7·7–30·5% ( P <0·001). Dichotomized at the median, patients with a score ≥4 derived a greater relative risk reduction with tirofiban ( P (Interaction)=0·025). Among patients with normal creatine kinase myocardial bands, the risk score showed a 3·5-fold gradient of risk ( P <0·001) and identified a population that derived significant benefit from tirofiban (RR 0·73, P =0·027). Conclusion The TIMI Risk Score is a simple clinical tool for risk assessment that may aid in the early identification of patients who should be considered for treatment with potent antiplatelet therapy.