Copyright © 2002 by the European Society of Cardiology.
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
a Department of Medicine, Brigham and Women's Hospital, Boston, MA, U.S.A.
b Merck & Co. Whitehouse Station, NJ, U.S.A.
c Montreal Heart Institute, Montreal, Canada
revised April 9, 2001; accepted April 11, 2001
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.
Key Words: coronary disease, prognosis, myocardial infarction, unstable angina, platelet inhibitors
f1 Correspondence: David A. Morrow, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, U.S.A.
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