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 for unstable angina or non-ST-elevation myocardial infarction (NSTEMI) is a clinical prediction rule that originally was developed to predict the likelihood of morbidity in patients with unstable angina or NSTEMI.[1]

The TIMI Risk Score for unstable angina or NSTEMI has also been used to detect patients with chest pain who are at increased risk of acute coronary syndrome.[2][3]

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

One study found that "the incidence of 30-day death, myocardial infarction, or revascularization for patients with a clinical impression of an alternative diagnosis and a TIMI score of 0 was 2.9%."[2]

The risk of either death, myocardial infarction, or urgent myocardial revascularization according to the number of points:[1]

  • 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.[4]

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."[5] 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.[6]

References

  1. 1.0 1.1 Antman EM, Cohen M, Bernink PJ, 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. [e] printable card
  2. 2.0 2.1 Campbell CF, Chang AM, Sease KL, Follansbee C, McCusker CM, Shofer FS et al. (2009). "Combining Thrombolysis in Myocardial Infarction risk score and clear-cut alternative diagnosis for chest pain risk stratification.". Am J Emerg Med 27 (1): 37-42. DOI:10.1016/j.ajem.2008.01.028. PMID 19041531. Research Blogging. Cite error: Invalid <ref> tag; name "pmid19041531" defined multiple times with different content
  3. Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE (2006). "Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population.". Acad Emerg Med 13 (1): 13-8. DOI:10.1197/j.aem.2005.06.031. PMID 16365321. Research Blogging.
  4. Cannon CP, Weintraub WS, Demopoulos LA, et al (2001). "Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban". N. Engl. J. Med. 344 (25): 1879-87. PMID 11419424. [e]
  5. Anderson JL, Adams CD, Antman EM, et al (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". J. Am. Coll. Cardiol. 50 (7): e1–e157. DOI:10.1016/j.jacc.2007.02.013. PMID 17692738. Research Blogging.
  6. García-Almagro FJ, et al. Prognostic value of the Thrombolysis in Myocardial Infarction risk score in a unselected population with chest pain. Construction of a new predictive model. Am J Emerg Med. 2008 May;26(4):439-45. PMID 18410812

External links

Online calculator for TIMI