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To determine value of TIMI risk score in evaluation of patients admitted with cocaine associated chest pain (CACP).
It has been shown that in patients with unstable angina/Non-ST Elevation myocardial infarction (NSTEMI), the TIMI risk score categorizes a patient’s risk of death, ischemic events and helps to identify individuals who should be treated with an early invasive strategy. CACP even with NSTEMI can be due to coronary vasoconstriction/increased demand and does not necessarily indicate underlying coronary artery disease (CAD). We sought to investigate the usefulness of TIMI risk score in patients with CACP.
Retrospectively data of 84 consecutive patients who presented with CACP with urine positive screen in the years 2002-2010 were analyzed. TIMI risk score was calculated by reviewing the admission chart. Obstructive CAD was defined as; more than 70% narrowing in one of the epicardial arteries, Positive stress test (PST) was defined as an abnormal nuclear scan showing ischemia at least in one vessel territory. Non-obstructive CAD was defined as negative nuclear stress test or non obstructive CAD by coronary angiogram (CA).
Among 84 patients, 52 were classified as low risk (score 0, 1) and 32 as intermediate/ high risk (≥ 2) TIMI risk score. 96% of patients in the low TIMI risk group did not have positive stress test or obstructive CAD in CA. 83% of patients with obstructive CAD or PST had intermediate/high TIMI risk score. Chi square test revealed that TIMI risk score was significantly higher in obstructive CAD/PST patients compared to non obstructive CAD group (Chi sq 12.15, DIF=1, p=0.01, Odds Ratio=11.364).
In hospitalized patients with CACP, TIMI risk score can be used to predict presence or absence of obstructive CAD and can assist in decision of invasive or non-invasive treatment strategy.