Comparison of prediction between TIMI (Thrombolysis in Myocardial Infarction) risk score and Modified TIMI risk score in discharged patients from emergency department with atypical chest pain
In a prospective-analytic study, all patients with chief complaints of atypical chest pain aged over 25 years old will be included. Later, the emergency medicine attending will decide on hospitalizing or discharging patients based on the criteria explained in two systems (TIMI risk score and Modified TIMI risk score). Based on TIMI risk score (0 or 1) and Modified TIMI risk score (0 or 1), patients will randomly be divided into 2 equal groups.
Seven criteria are evaluated in the TRS scoring; each criterion equals to one score. The criteria include:
1. Age> 65 years
2. Confirmed cardiovascular stenosis>50%
3. Three or more associated cardiac risk factors
4. Administration of aspirin within the previous week
5. Occurrence of at least two chest pains within the past 24 hours
6. ECG changes except for STEMI
7. Increased cardiac biomarkers
Using the scoring system enables us to classify the patients and evaluate the degree of race based on which further decision on either admitting or discharging patients would be made. It should be mentioned that in the Modified TIMI Risk Score (MTRS), raised criteria are similar to the TRS approach but the scoring is between 0-10 and a score of 5 has been considered for either ECG or cardiac biomarker changes in case of being positive (with a maximum score of five for the sum of both items). TIMI and Modified TIMI risk scores were evaluated regarding the prediction of the adverse events within 30 days (all-cause death, myocardial infarction, and coronary revascularization).
General information
Acronym
IRCT registration information
IRCT registration number:IRCT201304182496N9
Registration date:2013-04-28, 1392/02/08
Registration timing:retrospective
Last update:
Update count:0
Registration date
2013-04-28, 1392/02/08
Registrant information
Name
Hassan Soleimanpour
Name of organization / entity
Tabriz University of Medical Sciences
Country
Iran (Islamic Republic of)
Phone
+98 41 1329 1286
Email address
soleimanpourh@tbzmed.ac.ir
Recruitment status
Recruitment complete
Funding source
Research-Vice chancellor, Tabriz University of Medical Sciences, Iran
Expected recruitment start date
2011-06-19, 1390/03/29
Expected recruitment end date
2012-06-18, 1391/03/29
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
Comparison of prediction between TIMI (Thrombolysis in Myocardial Infarction) risk score and Modified TIMI risk score in discharged patients from emergency department with atypical chest pain
Public title
Comparison of prediction between TIMI (Thrombolysis in Myocardial Infarction) risk score and Modified TIMI risk score in discharged patients from emergency department with atypical chest pain
Purpose
Prevention
Inclusion/Exclusion criteria
Inclusion criteria: All patients with chief complaints of atypical chest pain aged over 25 years old. Exclusion criteria: patients with the diagnosis of STEMI; patients younger than 25 years old; patients being hospitalized due to other reasons including dialysis requirements in CRF patients and myocardial contusion following chest trauma; pregnant women; imprisoned patients and unavailability of the follow-up for patients.
Age
From 25 years old to 100 years old
Gender
Both
Phase
N/A
Groups that have been masked
No information
Sample size
Target sample size:
1000
Randomization (investigator's opinion)
Randomized
Randomization description
Blinding (investigator's opinion)
Not blinded
Blinding description
Placebo
Not used
Assignment
Parallel
Other design features
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Research Vice chancellor of Tabriz University of Medical Sciences
Street address
Research Vice chancellor of Tabriz University of Medical Sciences ,Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, I.R IRAN.
City
Tabriz
Postal code
51664
Approval date
2011-01-05, 1389/10/15
Ethics committee reference number
8966
Health conditions studied
1
Description of health condition studied
Atypical chest pain
ICD-10 code
I20.9
ICD-10 code description
Angina pectoris, unspecified
Primary outcomes
1
Description
Atypical chest pain
Timepoint
on arrival and until 12 hours following symptoms onset
Method of measurement
ECGs and cardiac enzymes
Secondary outcomes
1
Description
Adverse events
Timepoint
One month after admission in the emergency department
Method of measurement
All patients were followed up regarding the adverse events ((Myocardial Infarction (MI), revascularization and death)) and questionnaire form
Intervention groups
1
Description
Group I was evaluated using TRS and its patients were discharged in case of having low risk (0-1). All criteria used in TRS method are of equal values and each score one. These criteria include:
1. increased cardiac markers: measurements of T troponin 12 hours after the primary chest pain onset
2. Ischemic ECG: ECG registration on admission
3. Age>65
4. Continuous administration of aspirin or history of consumption within previous seven days
5. three risk factors: patients should have at least three risk factors including diabetes mellitus, hypertension, hyperlipidemia, and familial history of cardiac diseases in the close relatives before the age of 65 years and smoking history within six previous weeks
6. previously-diagnosed cardiovascular stenosis
7. severe symptoms: two or more episodes of chest pain within the previous 24 hours or pain duration of more than one hour
Category
Prevention
2
Description
Patients in group II were evaluated regarding their risk factors using MTRS method and were discharged in case of having low risk (0-1). The criteria used in MTRS system are similar to that of TRS. The only difference is scoring is between 0-10 and a score of 5 has been considered for ECG or cardiac biomarker changes (items seven and six) in case of being positive (all together or separately).
Category
Prevention
Recruitment centers
1
Recruitment center
Name of recruitment center
Madani Hospital
Full name of responsible person
Dr.Hassan Soleimanpour
Street address
Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, I.R IRAN. Tabriz
City
Tabriz
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
Research Vice chancellor of Tabriz University of Medical Sciences
Full name of responsible person
Dr.seyed kazem shakouri
Street address
Research Vice chancellor of Tabriz University of Medical Sciences ,Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, I.R IRAN
City
Tabriz
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Research Vice chancellor of Tabriz University of Medical Sciences
Proportion provided by this source
100
Public or private sector
empty
Domestic or foreign origin
empty
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
empty
Person responsible for general inquiries
Contact
Name of organization / entity
Tabriz University of Medical Sciences
Full name of responsible person
Dr.Hassan Soleimanpour
Position
Anesthesiologist/ Associate professor of Anesthesiology, MD
Other areas of specialty/work
Street address
Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, I.R IRAN. Tabriz
City
Tabriz
Postal code
51664
Phone
+98 41 1335 2078
Fax
+98 41 1335 2078
Email
h_mofid1357@yahoo.com
Web page address
Person responsible for scientific inquiries
Contact
Name of organization / entity
Tabriz University of Medical Sciences
Full name of responsible person
Dr.Hassan Soleimanpour
Position
Anesthesiologist/ Associate professor of Anesthesiology, MD
Other areas of specialty/work
Street address
Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, I.R IRAN. Tabriz
City
Tabriz
Postal code
51664
Phone
+98 41 1335 2078
Fax
+98 41 1335 2078
Email
h_mofid1357@yahoo.com
Web page address
Person responsible for updating data
Contact
Name of organization / entity
Tabriz University of Medical Sciences
Full name of responsible person
Dr.Hassan Soleimanpour
Position
Anesthesiologist/Associate professor of Anesthesiology, MD
Other areas of specialty/work
Street address
Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, I.R IRAN. Tabriz
City
Tabriz
Postal code
51664
Phone
+98 41 1335 2078
Fax
+98 41 1335 2078
Email
h_mofid1357@yahoo.com
Web page address
Sharing plan
Deidentified Individual Participant Data Set (IPD)