TIMI risk score: Difference between revisions

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==Overview==
==Overview==
The [[TIMI]] Risk Score provides prognostic information regarding the risk of future adverse clinical outcome 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]].
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==
==TIMI Risk Score for Unstable Angina==
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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.<ref name="pmid10938172">{{cite journal| author=Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G et al.| title=The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. | journal=JAMA | year= 2000 | volume= 284 | issue= 7 | pages= 835-42 | pmid=10938172 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10938172  }} </ref>
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.<ref name="pmid10938172">{{cite journal| author=Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G et al.| title=The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. | journal=JAMA | year= 2000 | volume= 284 | issue= 7 | pages= 835-42 | pmid=10938172 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10938172  }} </ref>


A score of 1 is assigned to each risk factor that is present, and the number of risk factors is added up to arrive at the TIMI Risk Score for [[UA]]/[[NSTEMI]].  The total possible score is 7.<ref name="pmid10938172">{{cite journal| author=Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G et al.| title=The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. | journal=JAMA | year= 2000 | volume= 284 | issue= 7 | pages= 835-42 | pmid=10938172 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10938172  }} </ref>
'''[[TIMI Risk Score for Unstable Angina or NSTEMI|TIMI Risk Score Calculator for Unstable Angina or NSTEMI]]'''


* Age (equal or greater than 65 years) = 1
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
* [[Cardiac enzymes]] (raised serum cardiac markers) = 1
|-
* [[EKG]] ([[ST segment|ST segment depression]] at presentation) = 1
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Risk Factor
* [[Risk factor]]s (at least three for [[coronary artery disease]]) = 1
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Points
* [[Ischemia]] (at least two anginal events in previous 24 hours) = 1
|-
* [[Coronary artery disease|Coronary artery stenosis]] (prior stenosis of 50% or more) = 1
| align="left" style="background:#F5F5F5;" + |Age (equal or greater than 65 years)
* [[Aspirin]] (use in previous 7 days) = 1
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |[[Cardiac enzymes]] (raised serum cardiac markers)
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |[[EKG]] ([[ST segment|ST segment depression]] at presentation)
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |[[Risk factor]]s (at least three for [[coronary artery disease]])
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |[[Ischemia]] (at least two anginal events in previous 24 hours)
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |[[Coronary artery disease|Coronary artery stenosis]] (prior stenosis of 50% or more)
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |[[Aspirin]] (use in previous 7 days)
| align="center" style="background:#F5F5F5;" + |1
|}


===Interpretation of TIMI Risk Score for Unstable Angina===
===Interpretation of TIMI Risk Score for Unstable Angina===
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{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 30%" align=center |'''Score'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Risk of the all-cause mortality, myocardial infarction, or severe recurrent ischemia through 14 days'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 30%" align="center" |'''Score'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Risk of the all-cause mortality, myocardial infarction, or severe recurrent ischemia through 14 days'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''0-1''' || style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |4.7% risk
| align="center" style="background:#F5F5F5;" + |0-1
| align="center" style="background:#F5F5F5;" + |4.7% risk
|-
|-
| style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |''' 2''' || style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |8.3% risk
| align="center" style="background:#F5F5F5;" + |2
| align="center" style="background:#F5F5F5;" + |8.3% risk
|-
|-
|style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |'''3''' || style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |13.2% risk
| align="center" style="background:#F5F5F5;" + |3
| align="center" style="background:#F5F5F5;" + |13.2% risk
|-
|-
|style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |'''4''' || style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |19.9% risk
| align="center" style="background:#F5F5F5;" + |4
| align="center" style="background:#F5F5F5;" + |19.9% risk
|-
|-
|style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |'''5''' || style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |26.2% risk
| align="center" style="background:#F5F5F5;" + |5
| align="center" style="background:#F5F5F5;" + |26.2% risk
|-
|-
|style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |'''6-7''' || style="font-size: 100%; padding: 0 5px; background: #B8B8B8" align=left |at least 40.9% risk
| align="center" style="background:#F5F5F5;" + |6-7
| align="center" style="background:#F5F5F5;" + |at least 40.9% risk
|}
|}


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===Calculation of 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.<ref name="pmid11044416">{{cite journal| author=Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA et al.| title=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. | journal=Circulation | year= 2000 | volume= 102 | issue= 17 | pages= 2031-7 | pmid=11044416 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11044416  }} </ref>
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.<ref name="pmid11044416">{{cite journal| author=Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA et al.| title=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. | journal=Circulation | year= 2000 | volume= 102 | issue= 17 | pages= 2031-7 | pmid=11044416 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11044416  }} </ref>
*Demographic data and medical history  
 
:*Age ≥75 years = 3
'''[[TIMI Risk Score for STEMI|TIMI Risk Score Calculator for STEMI]]'''
:*Age 65–74 years = 2
 
:*History of [[diabetes mellitus]] or [[hypertension]] or [[angina]] = 1
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
*Physical examination
|-
:*Systolic blood pressure <100 = 3
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Risk Factor
:*Heart rate >100 = 2
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Points
:*Killip class II–IV = 2
|-
:*Weight <67 kg = 1
! rowspan="3" align="center" style="background:#DCDCDC;" + |Demographic data and medical history
*Evaluation at presentation
| align="left" style="background:#F5F5F5;" + |Age ≥75 years
:*Anterior ST elevation or [[left bundle branch block]] = 1
| align="center" style="background:#F5F5F5;" + |3
:*Time to therapy >4 hours = 1
|-
| align="left" style="background:#F5F5F5;" + |Age 65–74 years
| align="center" style="background:#F5F5F5;" + |2
|-
| align="left" style="background:#F5F5F5;" + |History of [[diabetes mellitus]] or [[hypertension]] or [[angina]]
| align="center" style="background:#F5F5F5;" + |1
|-
! rowspan="4" align="center" style="background:#DCDCDC;" + |Physical examination
| align="left" style="background:#F5F5F5;" + |Systolic blood pressure <100
| align="center" style="background:#F5F5F5;" + |3
|-
| align="left" style="background:#F5F5F5;" + |Heart rate >100
| align="center" style="background:#F5F5F5;" + |2
|-
| align="left" style="background:#F5F5F5;" + |Killip class II–IV
| align="center" style="background:#F5F5F5;" + |2
|-
| align="left" style="background:#F5F5F5;" + |Weight <67 kg
| align="center" style="background:#F5F5F5;" + |1
|-
! rowspan="2" align="center" style="background:#DCDCDC;" + |Evaluation at presentation
| align="left" style="background:#F5F5F5;" + |Anterior ST elevation or [[left bundle branch block]]
| align="center" style="background:#F5F5F5;" + |1
|-
| align="left" style="background:#F5F5F5;" + |Time to therapy >4 hours
| align="center" style="background:#F5F5F5;" + |1
|}


===Interpretation of TIMI Risk Score for STEMI===
===Interpretation of TIMI Risk Score for STEMI===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 30%" align=center |'''Score'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''30 Day Mortality (%)'''<ref name="pmid11044416">{{cite journal| author=Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA et al.| title=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. | journal=Circulation | year= 2000 | volume= 102 | issue= 17 | pages= 2031-7 | pmid=11044416 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11044416  }} </ref>
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 30%" align="center" |'''Score'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''30 Day Mortality(%)'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''0''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |0.8%
| align="center" style="background:#F5F5F5;" + |0
| align="center" style="background:#F5F5F5;" + |0.8%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''1''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1.6%
| align="center" style="background:#F5F5F5;" + |1
| align="center" style="background:#F5F5F5;" + |1.6%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''2''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.2%
| align="center" style="background:#F5F5F5;" + |2
| align="center" style="background:#F5F5F5;" + |2.2%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''3''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |4.4%
| align="center" style="background:#F5F5F5;" + |3
| align="center" style="background:#F5F5F5;" + |4.4%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''4''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |7.3%
| align="center" style="background:#F5F5F5;" + |4
| align="center" style="background:#F5F5F5;" + |7.3%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''5''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |12.4%
| align="center" style="background:#F5F5F5;" + |5
| align="center" style="background:#F5F5F5;" + |12.4%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''6''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |16.1%
| align="center" style="background:#F5F5F5;" + |6
| align="center" style="background:#F5F5F5;" + |16.1%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''7''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |23.4%
| align="center" style="background:#F5F5F5;" + |7
| align="center" style="background:#F5F5F5;" + |23.4%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''8''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |26.8%
| align="center" style="background:#F5F5F5;" + |8
| align="center" style="background:#F5F5F5;" + |26.8%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''>8''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |35.9%
| align="center" style="background:#F5F5F5;" + |>8
| align="center" style="background:#F5F5F5;" + |35.9%
|}
|}


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{{Reflist|2}}
{{Reflist|2}}


{{Electrocardiography}}
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{{Circulatory system pathology}}
 
 
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Latest revision as of 00:25, 30 July 2020

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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
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. ↑ 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.
  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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