Correlation of TIMI Score and Killip Class with MACE In Non ST Elevation Myocardial Infarction

OBJECTIVES: Non-ST-elevation myocardial infarction (NSTEMI) constitutes  a significant proportion of acute coronary syndromes (ACS) and is a leading cause of morbidity and mortality worldwide.  TIMI score and Killip class are easily obtained clinical parameters to predict MACE . The objective of this study is to assess the correlation of TIMI score and Killip class  with MACE  in Non ST elevation myocardial  infarction

METHODS : The study included 154 patients who presented to the Department of Cardiology, NEIGRIHMS, Shillong with NSTEMI . Non-STEMI  myocardial infarction is character­ized by abnormal cTnI ≥ 0.04 ng/ml.  A 12-lead ECG was performed at admission in all cases and then at 6, 12, 18, 24 and 48 h post-admission.  Blood samples were obtained after ≥ 6 hours since the beginning of the last episode of chest pain to assess cTnT .TIMI score and Killip class was calculated on admission . Major clinical events (MCE) observed up to 30 days post-dis­charge and considered as composite endpoint are: cardiac death, non-fatal myocardial and recurrent angina which led to ci­ne coronary angiography, and according to the results, the ensuing urgent revascularization treatment within 30 days of admis­sion. Patients were divided into two groups according to the presence (group A) or absence (group B) of MACE . A ROC curve was generated to relate the TIMI score and Killip class  with major cardiovascular events Sensitivity, specificity and positive predictive value was estimated for TIMI score and Killip classification    for presence or absence of major cardiovascular events.

RESULTS: The mean TIMI score in patients with MACE  was 3.76±0.75  and  was significantly higher  in patients without MACE 2.24±0.84 (p≤0.001).

In 33 of the 38 patients with MACE   the TIMI SCORE was more than 2 while 51 of the 116 patients without MACE had TIMI SCORE>2. The number of  patients with TIMI SCORE>2 had significantly higher rate of MACE . (p≤0.001).

28 OF THE 38 patients with MACE had KILLIP CLASS > 1 ; while 15 of 116 patients without MACE had KILLIP CLASS > 1. The number of  patients with KILLIP CLASS > 1had significantly higher rate of MACE . (p=0.004).

CONCLUSION: There is a significant  correlation between TIMI score and Killip Class  in prognosis of patients with Non ST elevation Myocardial Infarction   . TIMI score and Killip class are easily available tools to predict  MACE