Renal impairment was determined based on medically documented reports of moderate to severe chronic kidney disease (CKD) CKD Stage 3 and above (e-GFR below 60 ml/min). Diabetes mellitus (DM) status was determined based on self report, or use of blood sugar lowering agents (oral or insulin). All clinical care given to patients presenting with STEMI was at the discretion of the treating physician or cardiologist at the respective sites. The diagnosis of STEMI is based on the following signs and symptoms of ACS (chest pain or overwhelming shortness of breath), elevated serum cardiac biomarkers and an ST elevation in contiguous leads of the electrocardiogram or the development of a new left bundle branch block (LBBB). This study made use of anonymized data from patients who presented with STEMI registered from 1 st January 2006 till 31 st December 2008 with follow up details recorded till 31 st December 2009. Instead, a public notice is displayed at all sites and patients are given the option to opt out of the NCVD. A waiver of informed consent was obtained from the Ministry of Health Medical Research and Ethics Committee. The NCVD is registered in the National Medical Research Register of Malaysia (ID: NMRR-07-38-164) and received ethical approval from the Ministry of Health Medical Research and Ethics Committee. We also sought to determine if the TIMI risk score was useful prognostically in subgroups of patients with diseases that are more prevalent in the country and at higher risk of mortality diabetics and those with renal impairment. In this study, we studied whether the TIMI risk score can be applied, i.e., results in adequate risk assessment, in a multi-ethnic Malaysian population presenting with STEMI. In Malaysia, patients presenting with STEMI are younger, have a much higher prevalence of diabetes, hypertension and renal failure, and present later to medical care than their western counterparts. However, it is not known how the TIMI risk score performs in a population with many characteristic differences from the population the risk score was derived from, in the era where an early invasive strategy for re-vascularisation is becoming more common. This offers some evidence for its clinical applicability in risk stratification and prognostication. The TIMI risk score has shown to provide good discrimination in predicting mortality at 30 days and even up to 365 days.
It was developed in a clinical trial population, and has been validated in non-selected Western patient populations. This low cost risk estimation may be very suitable for use in developing countries. The Thrombolysis In Myocardial Infarction (TIMI) risk score was developed as a bedside tool to stratify STEMI patients eligible for reperfusion by their mortality risk. In this respect, risk stratification of patients with STEMI takes on greater importance, especially for those at the highest risk strata, such that the most resource intensive strategies can be applied to achieve the greatest clinical benefit. In developing countries, where there is a wide variation of healthcare service provision, it is often challenging to provide the best treatment strategies recommended in international guidelines. ST-segment elevation myocardial infarction (STEMI) forms the severest spectrum of ACS and the best clinical outcomes are achieved when the primary percutaneous coronary intervention (PCI) strategy is applied. It provides information to both patients and clinicians on the possible prognosis and serves as a guide to aggressiveness of treatment. Risk stratification is important in acute coronary syndromes (ACS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This work was supported by a University of Malaya/Ministry of Higher Education, Malaysia (UM/MOHE) High Impact Research Grant (Grant number E000014–20001). Received: Accepted: JPublished: July 16, 2012Ĭopyright: © 2012 Selvarajah et al. PLoS ONE 7(7):Įditor: Andrea Zuffi, Policlinico San donato milanese, Italy Citation: Selvarajah S, Fong AYY, Selvaraj G, Haniff J, Uiterwaal CSPM, Bots ML (2012) An Asian Validation of the TIMI Risk Score for ST-Segment Elevation Myocardial Infarction.