TIMI Score (NSTEMI / Unstable Angina)
Estimates the 14-day risk of mortality, new infarction, or severe ischemia requiring urgent revascularization.
Check all criteria present in the patient (1 point each):
The TIMI Score: Rapid Assessment of Non-ST ACS
The TIMI (Thrombolysis In Myocardial Infarction) risk score for unstable angina and NSTEMI (non-ST elevation myocardial infarction) is one of the most classic and easy-to-use clinical scores in cardiology and emergency medicine. It rapidly stratifies the risk of major adverse cardiac events (death, new myocardial infarction, or severe ischemia requiring urgent revascularization) within 14 days of admission.
The 7 Criteria of the TIMI Score
The score is based on 7 simple variables worth 1 point each, divided into three categories: patient history, clinical presentation, and baseline tests (ECG, Troponin).
- History: Age ≥ 65 years, at least 3 cardiovascular risk factors, known coronary artery disease (stenosis ≥ 50%), recent aspirin use.
- Presentation: Severe unstable angina (≥ 2 episodes in 24h).
- Testing: ECG abnormalities (ST deviation) and elevated cardiac enzymes.
Therapeutic Guidelines
A high TIMI score (≥ 5) indicates a major risk (nearly 40% complications at 14 days) justifying immediate admission to a cardiac intensive care unit (CCU), the use of potent antithrombotics (e.g., GPIIb/IIIa inhibitors), and an early invasive strategy (coronary angiography). A low score (0-2) allows for a more conservative approach and non-invasive ischemia testing, although the GRACE score is now often preferred for its greater overall predictive accuracy.
Risk of Events (Death/MI/Ischemia) at 14 Days
| TIMI Score | Risk Level | 14-Day Event Risk |
|---|---|---|
| 0 - 2 pts | Low Risk | 4.7% - 8.3% |
| 3 - 4 pts | Intermediate Risk | 13.2% - 19.9% |
| 5 - 7 pts | High Risk | 26.2% - 40.9% |
References:
1. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-842. [NIH - PubMed]
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