TIMI risk score

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2],Sadaf Sharfaei M.D.[3]

Overview

The TIMI Risk Score provides prognostic information regarding the risk of future adverse clinical outcomes among patients with acute coronary syndromes. There are separate scores for patients with unstable angina or non ST elevation myocardial infarction and ST elevation myocardial infarction.

TIMI Risk Score for Unstable Angina

Calculation of TIMI Risk Score for Unstable Angina or Non ST Segment Elevation MI (NSTEMI)

The TIMI risk score for unstable angina (UA) or Non ST Segment Elevation MI (NSTEMI) was derived in the test cohort by selection of independent prognostic variables using multivariate logistic regression, assignment of value of 1 when a factor was present and 0 when it was absent, and summing the number of factors present to categorize patients into a level of risk.^[1]

TIMI Risk Score Calculator for Unstable Angina or NSTEMI

Risk Factor	Points
Age (equal or greater than 65 years)	1
Cardiac enzymes (raised serum cardiac markers)	1
EKG (ST segment depression at presentation)	1
Risk factors (at least three for coronary artery disease)	1
Ischemia (at least two anginal events in previous 24 hours)	1
Coronary artery stenosis (prior stenosis of 50% or more)	1
Aspirin (use in previous 7 days)	1

Interpretation of TIMI Risk Score for Unstable Angina

The risk at 14 days of either all-cause death, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization is as follows:^[1]

Score	Risk of the all-cause mortality, myocardial infarction, or severe recurrent ischemia through 14 days
0-1	4.7% risk
2	8.3% risk
3	13.2% risk
4	19.9% risk
5	26.2% risk
6-7	at least 40.9% risk

TIMI Risk Score for STEMI

Calculation of TIMI Risk Score for STEMI

The TIMI risk score for TIMI is calculated by adding the numbers assigned to the different criteria shown below. The total possible score is 14.^[2]

TIMI Risk Score Calculator for STEMI

Risk Factor		Points
Demographic data and medical history	Age ≥75 years	3
	Age 65–74 years	2
	History of diabetes mellitus or hypertension or angina	1
Physical examination	Systolic blood pressure <100	3
	Heart rate >100	2
	Killip class II–IV	2
	Weight <67 kg	1
Evaluation at presentation	Anterior ST elevation or left bundle branch block	1
Evaluation at presentation	Time to therapy >4 hours	1

Interpretation of TIMI Risk Score for STEMI

Score	30 Day Mortality(%)
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%

References

↑ ^1.0 ^1.1 Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G; et al. (2000). "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making". JAMA. 284 (7): 835–42. PMID 10938172.
↑ Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA; et al. (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): 2031–7. PMID 11044416.

[pmid10938172-1] 1.0 ^1.1 Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G; et al. (2000). "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making". JAMA. 284 (7): 835–42. PMID 10938172.

[pmid11044416-2] Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA; et al. (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): 2031–7. PMID 11044416.

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