Authors: S M Salman Habib, Abdul Rasheed Khan, Bushra Sabeen, Rizwan Khan, Riffat Sultana, Sultana Habib.
Objectives: The study aimed to compare diagnostic accuracy of TIMI clinical score and nuclear MPI in Non-STE-ACS.
Material and Methods: In this cross-sectional comparative study, a total of 94 patients were included for the year (June 2019 to May 2020) with history of chest pain; provisionally diagnosed either (i) Non-STEMI or (ii) unstable angina. Patients excluded from the study (i) having provisional diagnosis of STEMI (ii) NSTEMI patient with high risk TIMI score (iii) individuals having UA with low risk TIMI score (iv) having recent history of PCI or CABG within 30 days (v) with history of renal failure (vi) hemodynamically unstable patients and (vii) having non-cardiac chest pain. The study population was divided into two major groups on the basis of result of cardiac marker (troponin-I) i.e. NSTEMI (group-A: i.e. positive biomarkers having chest pain at time interval upto 12
hours; n=41) and Unstable angina (group-B: i.e. negative biomarkers for the same period; n=53). TIMI score was calculated of all enrolled patient on the basis of clinical risk score system. Further sub-grouping (A-I, A-II, B-I & B-II) was done using clinical TIMI score as: low risk (0-2), intermediate score (3-4) and high risk (score 5-7). Angiography was performed as gold standard in all groups.
Results: All true and false, positive or negative results were taken into account, and results were divided into groups and subgroups. The sensitivity and specificity of MPI in patients with “low risk TIMI score-NSTEMI” (subgroup A-I) were found to be 92.8% (95% CI 66.13-99.82) and 81.25% (95% CI 54.35- 5.9) with p-value of 0.0001; while sensitivity and specificity of MPI in patients with “intermediate TIMI score- NSTEMI” (subgroup A-II) were found to be 100% (95% CI 47.82-100) and 80.0% (95% CI 35.88-99.58) with p-value of 0.005. The data of subgroup A-I and A-II were found statistically significant while using “Coronary Angiography (CA) as gold standard”. The sensitivity and specificity of MPI in patients having “intermediate TIMI score UA” (subgroup B-I) were found to be 86.67% (95% CI 59.54-98.34), 82.6% (95% CI 68.78-97.45) with p-value of 0.0001; while sensitivity and specificity of MPI in patients having “high TIMI score UA” (subgroup B-II) were found to be 100% (95% CI 59.04-100) and 80.0% (95% CI 28.35-99.49%) with p-value of 0.0038. The data of subgroup B-I and B-II were also found statistically significant while using “Coronary Angiography as gold standard”.
Conclusion: This study concludes that TIMI score is not an ideal tool for exact categorization of patient with NSTE-ACS. Therefore; MPI is more specific to identify definite intermediate and high risk patients allowing early referral or intervention for management, and to reduce health cost burden.
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