TIMI Risk Score for STEMI

TIMI Risk Score for ST-Elevation Myocardial Infarction (STEMI)

The TIMI Risk Score for STEMI is a clinical tool used to predict 30-day mortality in patients presenting with ST-segment elevation myocardial infarction. It helps clinicians to quickly stratify risk and make informed treatment decisions.

Scoring Criteria

Risk Factor	Points
Age ≥ 75 years	+3
Age 65-74 years	+2
History of Angina, Hypertension, or Diabetes	+1
Systolic Blood Pressure < 100 mmHg	+3
Heart Rate > 100 bpm	+2
Killip Class II-IV	+2
Weight < 67 kg (150 lbs)	+1
Anterior ST Elevation or LBBB	+1
Time to Treatment > 4 hours	+1

Risk Stratification (30-Day Mortality)

Score	Mortality Risk
0	0.8%
1	1.6%
2	2.2%
3	4.4%
4	7.3%
5	12.4%
6	16.1%
7	23.4%
8	26.8%
>8	35.9%

Clinical Implications

This score provides a quantitative estimate of a patient's mortality risk, which can be invaluable for:

Patient Counseling: Informing patients and their families about the prognosis.
Treatment Decisions: Identifying high-risk patients who may require more aggressive interventions or transfer to a tertiary care center.
Resource Allocation: Guiding the use of critical care resources.

A higher TIMI score is associated with a stepwise increase in 30-day mortality and should prompt clinicians to consider more intensive management strategies.

References

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.
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.
O'Gara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E., Chung, M. K., de Lemos, J. A., ... & Zhao, D. X. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 61(4), e78-e140.