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Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: The TIMI Risk Score for Unstable Angina/Non–ST Elevation.

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Presentation on theme: "Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: The TIMI Risk Score for Unstable Angina/Non–ST Elevation."— Presentation transcript:

1 Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making JAMA. 2000;284(7):835-842. doi:10.1001/jama.284.7.835 Rates of all-cause mortality, myocardial infarction, and severe recurrentischemia prompting urgent revascularization through 14 days after randomizationwere calculated for various patient subgroups based on the number of riskfactors present in the test cohort (the unfractionated heparin group in theThrombolysis in Myocardial Infarction [TIMI] 11B trial; n = 1957) (see Table 1). Event rates increased significantlyas the TIMI risk score increased (P<.001 by χ2 for trend). Figure Legend:

2 Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making JAMA. 2000;284(7):835-842. doi:10.1001/jama.284.7.835 Rates of all-cause mortality, myocardial infarction, and severe recurrentischemia prompting urgent revascularization through 14 days after randomizationwere calculated for the enoxaparin and unfractionated heparin groups in theThrombolysis in Myocardial Infarction (TIMI) 11B trial and the Efficacy andSafety of Subcutaneous Enoxaparin in Unstable Angina and Non-Q-Wave MI trial(ESSENCE), based on the TIMI risk score. The pattern of increasing event rateswith increasing TIMI risk score was confirmed in all 3 validation cohorts(P<.001 by χ2 for trend). C statisticswere 0.65 for the unfractionated heparin group and 0.61 for the enoxaparingroup in TIMI 11B; and 0.65 for the unfractionated heparin group and 0.59for the enoxaparin group in ESSENCE. The rate of increase in events as morerisk factors were present was significantly lower in the enoxaparin groupin both studies (for TIMI 11B, P =.01; for ESSENCE, P =.03). Positive values for absolute risk difference(ARD) and number needed to treat to prevent 1 event (NNT) indicate calculationsfavoring enoxaparin, while negative values indicate calculations favoringunfractionated heparin. Figure Legend:

3 Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making JAMA. 2000;284(7):835-842. doi:10.1001/jama.284.7.835 Rates of all-cause mortality, myocardial infarction (MI), urgentrevascularization, and all-cause mortality or nonfatal MI through 14 daysafter randomization were calculated for the entire population in the Thrombolysisin Myocardial Infarction (TIMI) 11B trial based on the TIMI risk score. Therewas a progressive, significant increase in the rate of events for each endpoint as the TIMI risk score increased (P<.001by χ2 for trend for all). C statistics for the 4 end pointsshown were 0.74 (all-cause mortality), 0.66 (MI), 0.68 (urgent revascularization),and 0.63 (all-cause mortality/MI), respectively. Figure Legend:


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