Modified TIMI Risk Score of Body et al

 

Patient selection: acute chest pain in the Emergency Department

 

Outcomes: death, acute myocardial infarction, and/or urgent coronary revascularization

 

Modifications:

(1) change in weighting for 2 parameters (raised serum marker, ischemic ECG) to 5 points

(2) altered wording in some of the parameters

 

Parameters:

(1) age

(2) risk factors for coronary artery disease (family history of coronary artery disease, hypertension, hypercholesterolemia, diabetes mellitus, being a current smoker)

(3) significant coronary artery stenosis (stenosis on coronary angiography, previous coronary intervention, history of myocardial infarction)

(4) ischemic ECG (ST deviation) at presentation by initial treating physician

(5) severe anginal symptoms (number of anginal events in past 24 hours)

(6) use of aspirin within past 7 days

(7) elevated serum cardiac marker (troponin T concentration measured >= 12 hours after onset of most significant chest pain)

Parameter	Finding	Points
age	< 65 years	0
	>= 65 years	1
risk factors for coronary artery disease	<= 2 risk factors	0
	>= 3 risk factors	1
significant coronary artery stenosis	no	0
	yes	1
ischemic ECG	none	0
	present	5
severe anginal symptoms	2 or more episodes in past 24 hours	1
	pain lasting >= 1 hour	1
	neither	0
use of aspirin in last 7 days	no	0
	yes	1
serum cardiac marker	not elevated	0
	elevated	5

 

modified TIMI risk score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum risk score: 0

• maximum risk score: 15

• The cutoff was a score >= 3 (> 2).

 

Performance:

• The AUC of the ROC curve was 0.87 vs 0.77 for the original TIMI score.

• The cutoff of >= 3 had a sensitivity of 96% and specificity of 51%.

• The maximum Youden score was for a cutoff score of >= 5. But the authors wanted to optimize sensitivity in order to reduce false negatives.