Thrombolysis in Myocardial Infarction risk score for unstable angina or non-ST elevation myocardial infarction

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In medicine, the Thrombolysis in Myocardial Infarction (TIMI) Risk Score is a clinical prediction rule that can predict the likelihood of morbidity in patients with unstable angina or non-ST-elevation myocardial infarction.

Calculation

The TIMI risk score is scored as one point for each of the following:

• Age 65 years or older
• At least 3 risk factors for coronary artery disease (family history or coronary heart disease, hypertension, hypercholesterolemia, diabetes, current smoking)
• Prior coronary stenosis of 50% or more
• ST-segment deviation on electrocardiogram at presentation
• At least 2 anginal events in prior 24 hours
• Use of aspirin in prior 7 days
• Elevated serum cardiac markers

Interpretation

The risk of either death, myocardial infarction, or urgent myocardial revascularization according to the number of points:

• 0-1 point: 5%
• 2 points: 8%
• 3 points: 13%
• 4 points: 20%
• 5 points: 26%
• 6-7 points: 41%

Among patients with unstable angina or NSTEMI, those with a (TIMI) risk score of 3 or more may benefit from invasive management (PTCA) according to the TACTICS randomized controlled trial.

According to clinical practice guidelines, percutaneous transluminal coronary angioplasty (PTCA) is "indicated for patients with UA/NSTEMI who have no serious comorbidity and who have coronary lesions amenable to PCI and any of the high-risk features." High-risk features is later defined at "refractory angina or hemodynamic or electrical instability" or "elevated risk for clinical events" (high Thrombolysis in Myocardial Infarction (TIMI) risk score).

Modified Thrombolysis in Myocardial Infarction (mTIMI) risk score

An initial study, without external validation, suggests that the TIMI risk score can be improved by adding the variables ejection fraction < 35% and the presence of diabetes.