Usefulness of the thrombolysis in myocardial infarction risk index in acute heart failure: a pilot study

Am J Emerg Med. 2016 Dec;34(12):2351-2355. doi: 10.1016/j.ajem.2016.08.047. Epub 2016 Aug 27.


Background: Risk stratification in acute heart failure (AHF) is vital for both physicians and paramedical personals. Thrombolysis in myocardial infarction (TIMI) risk index (TRI) and modified TRI (mTRI) are novel and simple predictive risk indices that have been examined in patients with acute coronary syndrome.

Objective: In the current study, we evaluated the relationship among TRI, mTRI, and mortality in patients with AHF.

Methods: A total of 293 patients with AHF were retrospectively analyzed. The patients were divided into 2 groups: group 1 consisted of patients who survived and group 2 consisted of patients who died during a follow-up period of 120 days. Multivariate hierarchical logistic regression analysis was performed to evaluate the relationship among TRI, mTRI, and mortality.

Results: All causes of death occurred in 84 patients (28.6%). Thrombolysis in myocardial infarction risk index was significantly higher in patients who died during follow-up (20.2 ± 12.4 vs 14.8 ± 8.9). The new risk score showed good predictive value for 120-day mortality. Before laboratory analysis, in-multivariate hierarchical logistic regression analysis TRI remained as an independent risk factor for mortality (odds ratio, 2.56; P < .001). After the laboratory analysis, despite the fact that TRI has lost its predictive value, mTRI remained an independent risk factor for mortality (odds ratio, 2.08; P = .01).

Conclusion: The TRI is a simple and strong predictor of all-cause mortality in patients who were admitted with AHF. The current study reveals for the first time the strong predictive value of TRI in patients with AHF.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adult
  • Age Factors
  • Blood Pressure
  • Blood Urea Nitrogen
  • C-Reactive Protein / metabolism
  • Diuretics / therapeutic use
  • Female
  • Follow-Up Studies
  • Furosemide / therapeutic use
  • Heart Failure / mortality*
  • Heart Failure / physiopathology*
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Potassium / blood
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Sodium / blood
  • Survival Rate
  • Systole


  • Diuretics
  • Furosemide
  • C-Reactive Protein
  • Sodium
  • Potassium