Age ≥ 65 years (+1)
≥ 3 Risk Factors for CAD (+1)
Family hx, hypertension, hypercholesterolemia, diabetes, smoker
Known Coronary Artery Disease (+1)
Stenosis ≥ 50%
Aspirin use in past 7 days (+1)
Severe angina (+1)
≥ 2 episodes in last 24 hours
ST deviation ≥ 0.5 mm (+1)
Elevated cardiac markers (+1)
TIMI Risk Score for Unstable Angina/Non-ST Elevation Myocardial Infarction
The TIMI Risk Score is a widely used clinical prediction rule to risk-stratify patients with unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI). It helps predict the short-term risk of all-cause mortality, new or recurrent myocardial infarction (MI), or severe recurrent ischemia requiring urgent revascularization.
Scoring Criteria (1 point for each)
| Risk Factor | Mnemonic |
|---|---|
| Age ≥ 65 years | A |
| ≥ 3 risk factors for CAD (family history, hypertension, hypercholesterolemia, diabetes, smoking) | Markers |
| Known CAD (stenosis ≥ 50%) | C |
| Aspirin use in the past 7 days | A |
| Severe angina (≥ 2 episodes in 24h) | A |
| ST deviation ≥ 0.5 mm | S |
| Elevated cardiac markers | C |
Risk Stratification (at 14 days)
| Score | Risk of Adverse Events |
|---|---|
| 0-1 | 4.7% |
| 2 | 8.3% |
| 3 | 13.2% |
| 4 | 19.9% |
| 5 | 26.2% |
| 6-7 | 40.9% |
Clinical Application
The TIMI score is a simple tool that can be used upon patient presentation to guide therapeutic decisions.
- Low-risk patients (Score 0-2): May be managed with a more conservative approach.
- Intermediate-risk patients (Score 3-4): Often benefit from more intensive medical therapy and monitoring.
- High-risk patients (Score 5-7): Should be considered for an early invasive strategy, such as cardiac catheterization and revascularization.
The score helps clinicians identify high-risk patients who are most likely to benefit from aggressive treatments, including GP IIb/IIIa inhibitors and early coronary intervention.
References
- Antman, E. M., Cohen, M., Bernink, P. J., McCabe, C. H., Horacek, T., Papuchis, G., ... & Braunwald, E. (2000). The TIMI risk score for unstable angina/non–ST elevation MI: a method for prognostication and therapeutic decision making. JAMA, 284(7), 835-842.
- Morrow, D. A., Antman, E. M., Charlesworth, A., Cairns, R., Murphy, S. A., de Lemos, J. A., ... & Braunwald, E. (2000). TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation, 102(17), 2031-2037.
- Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., ... & Zieman, S. J. (2014). 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 64(24), e139-e228.
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