Description

The TIMI (Thrombolysis in Myocardial Infarction) risk score can be used to evaluate patients with unstable or non-ST elevation myocardial infarction. The score can stratify patients by risk and can be used to aid in therapeutic decision making. This was based on the TIMI IIB and ESSENCE trials.


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 on angiography (history of coronary artery stenosis)

(4) ST deviation

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

(6) use of aspirin within past 7 days

(7) elevated serum cardiac markers (CK-MB fraction and/or cardiac specific troponin level)

 

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

< 50% stenosis

0

 

>= 50% stenosis

1

ST deviation

none

0

 

transient elevation

1

 

persistent elevation or depression >= 0.5 mm (>= 0.05 mV)

1

severe anginal symptoms

none or 1 episode in past 24 hours

0

 

2 or more episodes in past 24 hours

1

use of aspirin in last 7 days

no

0

 

yes

1

serum cardiac markers

not elevated

0

 

one or both elevated

1

 

TIMI risk score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 7

• The higher the score, the greater the risk of all cause mortality and myocardial infarction.

• Patients with scores >= 3 benefit from an early invasive strategy and should be considered for early angiography.

 

TIMI Risk Score

Probability of All Cause Mortality or Nonfatal Myocardial Infarction

0 or 1

2.9%

2

2.9%

3

4.7%

4

6.7%

5

11.5%

6 or 7

19.4%

from Figure 3, page 840, Antman et al (2000)


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