Choosing hearts to treat

LONDON, August 17 (SPIS MedWire). Given the heterogeneous nature of unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI), patients have a wide spectrum of risk for death and cardiac ischemic events. A paper in this week's JAMA concludes that the TIMI (Thrombolysis in Myocardial Infarction) risk score accurately predicts outcomes in these patients and can assist therapeutic decision-making. Antman at Brigham and Women's Hospital, Boston, and multicenter colleagues collected data on patients enrolled in two phase III international, randomised, double-blind trials: TIMI 11B and ESSENCE (Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and non-Q-wave MI trial). A total of 1,957 patients with UA/NSTEMI were randomised to receive unfractionated heparin (test cohort) and 1,953 to receive enoxaparin in TIMI 11B, while 1,564 and 1,607 were assigned to heparin and anoxaparin, respectively, in ESSENCE. Antman et al then used multivariate logistic regression to select independent prognostic variables, assigning a score ...