Combining Thrombolysis in Myocardial Infarction risk score and clear-cut alternative diagnosis for chest pain risk stratification

Caren F. Campbell, Anna Marie Chang, Keara L. Sease, Christopher Follansbee, Christine M. McCusker, Frances S. Shofer, Judd E. Hollander

Research output: Contribution to journalArticle

28 Scopus citations


Objective: The Thrombolysis in Myocardial Infarction (TIMI) risk score is a validated risk stratification tool useful in patients with definite and potential acute coronary syndromes (ACS) but does not identify patients safe for discharge from the emergency department (ED). Likewise, the use of a clear-cut alternative noncardiac diagnosis risk stratifies patients but does not identify a group safe for discharge. We hypothesized that the presence of an alternative diagnosis in patients with a TIMI risk score less than 2 might identify a cohort of patients safe for ED discharge. Methods: In prospective cohort study, we enrolled ED patients with potential ACS. Data included demographics, medical history, components of the TIMI risk score, and whether the treating physician ascribed the condition to an alternative noncardiac diagnosis. Investigators followed the patients through the hospital course, and 30-day follow-up was done. The main outcome was 30-day death, myocardial infarction, or revascularization. Results: A total of 3169 patients were enrolled (mean age, 53.6 ± 14 years; 45% men; 67% black). There were 991 patients (31%) with an alternative diagnosis, 980 patients with a TIMI risk score of 0, and 828 with a TIMI score of 1. At low levels of TIMI risk (

Original languageEnglish (US)
Pages (from-to)37-42
Number of pages6
JournalAmerican Journal of Emergency Medicine
Issue number1
Publication statusPublished - Jan 2009
Externally publishedYes


ASJC Scopus subject areas

  • Emergency Medicine

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