Risk stratification in acute coronary syndromes—does the TIMI risk score work in unselected cases?

Background: Management of patients with an acute coronary syndrome (ACS) requires accurate risk stratification to guide appropriate therapy. Aim: To assess the utility of the TIMI risk score in stratifying patients with possible ACS in routine clinical practice. Design: Prospective observational study. Methods: We recruited 869 consecutive patients with a diagnosis of possible ACS attending the acute medical receiving unit of a district general hospital. The main outcome measures were recurrent myocardial infarction, urgent revascularization, and all-cause mortality. TIMI risk score was calculated for each patient, and each was also assigned a risk group based on electrocardiogram (ECG) changes and troponin levels only. After follow-up, Cox univariate and multivariate regression was used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the fit of the models. Results: Increasing TIMI risk score was associated with increased risk of events (p