TIMI risk score: Does it work equally well in both male and females?

Objective: The TIMI (Thrombolysis In Myocardial Infarction) risk score is a seven item risk stratification tool derived from trials of patients with non-ST segment elevation acute coronary syndromes (ACS) that has been validated in emergency department (ED) patients with potential ACS. We hypothesised that it might have different prognostic abilities in male and female patients. Methods: This was a prospective cohort study of ED patients with potential ACS. Data included demographics, medical and cardiac history, and components of the TIMI risk score. Investigators followed the hospital course daily. The main outcome was death, acute myocardial infarction (AMI), or revascularisation within 30 days as stratified by TIMI risk score and compared between genders using χ² tests. Results: There were 2022 patients enrolled: 1204 (60%) females and 818 (40%) males. The incidence of 30 day death, AMI, revascularisation (n=168) according to TIMI score is as follows (female vs male): TIMI 0 (n=670), 1.6% vs 2.0%, p=0.2; TIMI 1 (n=525), 4.6% vs 8.5%, p=0.02; TIMI 2 (n=378), 6.3% vs 10.4%, p=0.05; TIMI 3 (n=234), 6.5% vs 24.6%, p<0.001; TIMI 4 (n=157), 22.7% vs 24.4%, p=0.15; TIMI 5 (n=52), 35.5% vs 39.1%, p=0.2; TIMI 6 or 7 (n=6), 33.3% vs 66.7%, p=1.0. The relationship between TIMI score and outcome was highly significant (p<0.001) for each gender; however, males tended to have worse outcomes at lower TIMI risk scores. Conclusions: The TIMI risk score successfully risk stratifies both males and females with potential ACS at the time of ED presentation; however, males have worse outcomes at lower TIMI scores than females.