Association of the TIMI Risk Score with Angiographically Defined High-Risk Coronary Artery Disease (SYNTAX Score >32) in Patients with NSTEMI

Abstract

Objectives: To evaluate the association between the TIMI risk score and angiographically defined high-risk coronary artery disease (SYNTAX score >32) among patients presenting with NSTEMI. Methodology: This cross-sectional study included 237 patients aged 18–80 years presenting with NSTEMI at a tertiary-care cardiac center in Karachi, Pakistan. TIMI risk scores were calculated using standard clinical parameters at presentation, while SYNTAX scores were derived from coronary angiography performed during the index hospitalization. Patients were categorized into high-risk (SYNTAX >32) and non–high-risk groups. Statistical analyses included independent t-tests, chi-square tests, and receiver operating characteristic (ROC) curve analysis. Results: High-risk CAD was identified in 24 patients (10.1%). Patients with high-risk CAD demonstrated a significantly greater angiographic disease burden, predominantly characterized by three-vessel disease and left main involvement. The mean TIMI risk score did not differ significantly between patients with high-risk and non–high-risk CAD (3.8 ± 1.2 vs. 3.7 ± 1.2; p = 0.488). ROC analysis revealed limited discriminative ability of the TIMI risk score for identifying high-risk CAD (AUC = 0.543; 95% CI: 0.425–0.660; p = 0.493). Conclusion: In this Pakistani NSTEMI cohort, the TIMI risk score showed limited utility in identifying angiographically complex, high-risk coronary anatomy. These findings highlight the need for integrated clinical–anatomical risk assessment strategies and population-specific models to improve risk stratification in South Asian settings.