Evidence based therapies for elderly female STEMI patients are considerably underutilized, despite older women having worse prognosis than men. Mortality rate in elderly STEMI patients remains considerably higher as compared to younger patients, especially in women undergoing PPCI. The burden of acute coronary syndrome is gaining increasing significance as the number of older population in Pakistan is gradually increasing. Risk profile and disease severity of the patient by post procedure in-hospital status are presented in Table 2. The mean TIMI score was 5 with 40.3% (163) patients with TIMI score of more than 5 and post procedure in-hospital mortality rate of 6.4% (26). More than two-thirds, 72.8% (294), of patients in our study were diagnosed with multi-vessel disease LAD occlusion in 49.8% (201) and RCA occlusion in 39.9% (161) patients. In 68.3% (276) patients, PPCI was performed after more than 4 hours of symptoms onset. The median time duration from symptoms onset to the arrival to emergency room was 240 minutes and the median time from ER arrival to Cath lab activation was 70 minutes. Other than advanced age, other risk factors included hypertension (281 patients 69.6%), diabetes (160 patients 39.6%) and smoking (17 patients 4.2%). Median age of the patients was 70 years with 29.2% (118) of the patients aged 75 years and above. P-value less than or equal to 0.05 was considered statistically significant.ДЄ total of 404 elderly (в‰Ґ65 years) women undergoing PPCI for STEMI were included in this study. The optimal cut-off value of TIMI risk score was determined by computing the Youden Index and patients were stratified based on optimal cut-off and in-hospital mortality and post discharge short term outcomes were compared between the patient groups. The predictive value was determined using area under the curve (AUC) of receiver operating characteristic curve (ROC) of TIMI risk score with in-hospital mortality as state variable. The results of the logistic regression analysis were expressed as an odds ratio (OR) along with 95% confidence interval (CI). Univariate and multivariate logistic regression analysis were performed for the assessment of the association of TIMI risk score as well as other baseline characteristics of the patients, with post-procedure mortality. The categorical baseline and clinical characteristics were compared with study outcome by applying chi-square test, and the Mann-Whitney U test was performed to assess the TIMI risk score by study outcome. The Kolmogorov-Smirnov test was applied to the examine the normality of the continuous variables such as age (years), symptom onset to ER arrival time (min), ER to Lab (min), total Ischemic time (min), and TIMI risk score and appropriate mean В± SD or median were calculated. (IBM Corp., Armonk, NY, US) was used for the analysis of data. IBM SPSS Statistics for Windows, Version 21.0. Given that 1 in 4 middle aged adults present with evidence of coronary artery disease (CAD) in Pakistan, we aimed to determine the predictive value of TIMI risk score and its prognostic significance to profile the risk of mortality of elderly females who underwent PPCI in the largest вЂcardiac care centerвЂ™ of the country. Moreover, elderly patients with Acute Coronary Syndrome (ACS) are poorly analysed and underrepresented in clinical trials. The validation of this risk score in the South Asian population is essential given the differences in genetics, lifestyle, and healthcare delivery in comparison to developed nations. However, data evaluating the usefulness of the TIMI risk score in the South Asian population remains scarce. The вЂThrombolysis in myocardial Infarction (TIMI) risk scoreвЂ™ is a risk stratification model which has been shown to accurately predict post-PCI mortality in both genders, with the c-statistic value of 30-day mortality ranging from 0.72вЂ“0.84. Accurate post-PCI risk prediction in women is thus a necessity, to allow the delivery of appropriate therapeutic interventions to those at increased risk, and thus curtail mortality rates. A recent multicentre registry that included STEMI patients undergoing PPCI from 12 countries showed a remarkably higher 30-day mortality rate in women, as compared to men. Despite being the best management strategy with a decrease in number of re-infarctions, almost 10% of patients undergoing percutaneous coronary intervention (PCI) die within three years, with women having a higher rate of adverse outcomes than men. Primary percutaneous coronary intervention (PPCI) has played a significant role in reducing mortality rates in ST-segment elevation myocardial infarction (STEMI) patients.

Timi risk score