Dynamic TIMI risk score for STEMI.

Although there are multiple methods of risk stratification for st-elevation myocardial infarction (stemi),this study presents a prospectively validated method for reclassification of patients based on in-hospital events. a dynamic risk score provides an initial risk stratification and reassessment at discharge. the dynamic timi risk score for stemi was derived in extract-timi 25 and validated in triton-timi 38. baseline variables were from the original timi risk score for stemi. new variables were major clinical events occurring during the index hospitalization. each variable was tested individually in a univariate cox proportional hazards regression. variables with p<0.05 were incorporated into a full multivariable cox model to assess the risk of death at 1 year. each variable was assigned an integer value based on the odds ratio,and the final score was the sum of these values. the dynamic score included the development of in-hospital mi,arrhythmia,major bleed,stroke,congestive heart failure,recurrent ischemia,and renal failure. the c-statistic produced by the dynamic score in the derivation database was 0.76,with a net reclassification improvement (nri) of 0.33 (p<0.0001) from the inclusion of dynamic events to the original timi risk score. in the validation database,the c-statistic was 0.81,with a nri of 0.35 (p=0.01). this score is a prospectively derived,validated means of estimating 1-year mortality of stemi at hospital discharge and can serve as a clinically useful tool. by incorporating events during the index hospitalization,it can better define risk and help to guide treatment decisions.