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

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. 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). Methods and Results Developed in TIMI 1113, the risk score is calculated as the sum of seven presenting characteristics (age greater than or equal to65 years, greater than or equal to3 cardiac risk factors, documented coronary disease, recent severe angina, ST deviation greater than or equal to0.5 mm, 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. (C) 2001 The European Society of Cardiology.