Thrombolysis In Myocardial Infarction
Thrombolysis In Myocardial Infarction (TIMI) encompasses a set of clinical trials and guidelines for the disease-modifying treatment of acute myocardial infarction, using thrombolytic enzymes to dissolve the clot(s) blocking coronary arteries. The studies showed that prompt thrombolysis, in appropriately selected patients within hours after onset, can stop and reverse damage to the heart muscle.
clinical prediction rules used to diagnose either of:
- Thrombolysis in Myocardial Infarction risk score for ST-elevation myocardial infarction
- Thrombolysis in Myocardial Infarction risk score for unstable angina or non-ST elevation myocardial infarction
The Thrombolysis in Myocardial Infarction risk score for ST-elevation myocardial infarction is a clinical prediction rule to estimate the prognosis of patients with a myocardial infarction with elevation of the ST segment of the electrocardiogram.
The variables in the equation are: Age: (null)
- History of diabetes mellitus or hypertension or angina
- Systolic blood pressure less than 100 mmHg (13.3 kPa)
- Heart rate greater than 100 bpm?:
- Killip classification II - IV?:
- Weight < 150lbs (67 kg)
- Anterior ST segment changes or left bundle branch block on electrocardiogram
- Time to Treatment > 4 hrs
Among patients with unstable angina or NSTEMI and without ST-segment elevation (but may have other EKG evidence of ischemia such as ST-segment depression of ≥1 mm or transient ST-segment elevation or T-wave inversion of >3 mm) may benefit from early invasive management (percutaneous transluminal coronary angioplasty) if their TIMI risk score is 3 or more.
- Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA et al. (2000). "TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy.". Circulation 102 (17): 2031-7. PMID 11044416.
- Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G et al. (2000). "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making.". JAMA 284 (7): 835-42. PMID 10938172.
- Cannon CP, Weintraub WS, Demopoulos LA, et al (2001). "Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban". N. Engl. J. Med. 344 (25): 1879-87. PMID 11419424.
- Bach RG, Cannon CP, Weintraub WS, et al (2004). "The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes". Ann. Intern. Med. 141 (3): 186-95. PMID 15289215.