Primary percutaneous coronary intervention (PPCI) has played a significant role in reducing mortality rates in ST-segment elevation myocardial infarction (STEMI) patients. Even though it is the best management strategy and decreased in number of re-infarctions, it was noticed that almost 10% of patients underwent percutaneous coronary intervention (PCI) die within three years. Specially women having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce.
The study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients.
A retrospective analysis of elderly (>65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018 is done. Patients’ demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time were extracted from hospital records. The primary outcome was in-hospital mortality and post-discharge mortality reported on telephonic follow-up.
A total of 404 elderly women with a median age of 70 years were included. The mean TIMI score was 5.25±1.45 with 40.3% (163) patients of TIMI score > 5. In-hospital mortality rate was 6.4% (26) and was found to be associated with TIMI score (p<0.001). The in-hospital mortality rate increased from 3.1% at TIMI score of 0–4 to 34.6% at the score of 8.
On follow-up (16.43±7.40 months) of 211 (55.8%) patients, the overall mortality rate was 20.3%, and this was also associated with TIMI score (p<0.001). The mortality rate increased from 5.6% at the score of 0–4 to 54.5% at the score of 8. The predictive values (area under the curve) of TIMI risk score for in-hospital and post-discharge mortality were 0.709 (95% CI 0.591–0.827; p <0.001) and 0.689 (95% CI 0.608–0.770; p <0.001), respectively.
Mortality rate in elderly STEMI patients remains considerably higher as compared to younger patients, especially in women undergoing PPCI . Evidence based therapies for elderly female STEMI patients are considerably underutilized, despite older women having worse prognosis than men. The study concluded that the TIMI risk score is highly predictive of in hospital and post-discharge mortality with a c-statistics of 0.709 and 0.689 respectively.
Also, the importance of stratification and TIMI score can also be judged from our analysis where post-discharge mortality was at least two times more (30.9%) in patients discerned as high risk when compared to those in the lower risk strata (13.2%) further implying the need to have better targeted treatment and early management of those identified at an increased risk.
This confirms that TIMI risk score can be used as an early risk stratification tool to identify patients in which early therapeutic interventions could improve long term survival outcome, hence improving patient care.
Increased adverse outcomes were observed with higher TIMI risk score for in hospital and post-discharge follow-up. Therefore, the prognostic TIMI risk score is a robust tool in predicting both in-hospital as well as post-discharge mortality in elderly females. This study findings can be beneficial for clinicians where an existing validated risk tool provides an inexpensive method to evaluate patients.