TIMI risk score

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

TIMI Risk Score for Unstable Angina

Calculation of TIMI Risk Score for Unstable Angina

The TIMI risk score for unstable angina 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 risk stratification. The total possible score is 7.

• 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:

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

TIMI Risk Score for STEMI

Total possible score is 14

• 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 h = 1

Interpretation of TIMI STEMI Risk Score

Interpretation of TIMI STEMI Risk Score

Score	30 Day Mortality
0	0.8%
1	1.6%
2	2.2%
3	4.4%
4	?
5	12%
6	16%
7	23%
8	27%
>8	36%