Regular paperUsefulness of the TIMI risk score in predicting both short- and long-term outcomes in the Veterans Affairs Non–Q-Wave Myocardial Infarction Strategies In-Hospital (VANQWISH) Trial
Section snippets
Patient selection:
Details of the VANQWISH Trial design and methods have been previously published.2 VANQWISH was a multicenter, Veterans Affairs Cooperative study in which patients with non–Q-wave myocardial infarction were randomized to an invasive versus a conservative strategy for the use of cardiac catheterization. The primary end point was death or nonfatal myocardial infarction over a mean of 23 months.
Assignment of TIMI risk score for patients in VANQWISH:
A TIMI risk score was assigned to the patients in VANQWISH, based on the following variables: (1) age >65
Discrimination of TIMI risk score for combined end point:
The 4 TIMI risk groups were, by design, comparably sized: TIMI risk score 0 to 2 (n = 280; 30%); TIMI risk score 3 (n = 264; 29%); TIMI risk score 4 (n = 210; 23%); and TIMI risk score 5 to 7 (n = 165; 18%). The event rate for all patients in VANQWISH for the combined end points (death, nonfatal myocardial infarction, or urgent revascularization) was 10.3% at 30 days, 19.5% at 6 months, and 26.5% at 1 year. There was a modest, but statistically significant increase in events from the lowest to
discrimination of the TIMI risk score in VANQWISH:
We found that the TIMI risk score was modestly predictive of the 30-day composite end point of all-cause mortality, nonfatal myocardial infarction, and urgent revascularization in patients with a non–Q-wave myocardial infarction enrolled in the VANQWISH trial. We did not expect a significantly higher degree of discrimination, given that the TIMI risk score was only moderately predictive in the original development sample and the similarly modest discrimination of other risk scores for acute
Acknowledgements
The VANQWISH participating medical centers and their principal investigators have been previously described.2
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