MDCalc

TIMI Risk Score for UA/NSTEMI

Estimates mortality for patients with unstable angina and non-ST elevation MI.

Age ≥65
≥3 CAD risk factors
Hypertension, hypercholesterolemia, diabetes, family history of CAD, or current smoker
Known CAD (stenosis ≥50%)
ASA use in past 7 days
Severe angina (≥2 episodes in 24 hrs)
EKG ST changes ≥0.5mm
Positive cardiac marker

Result:

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Advice

  • Patients with a score of 0 or 1 point are at lower risk of adverse outcome (death, MI, urgent revascularization) compared to patients with a higher risk score. However, the risk is not zero.

  • Patients with a higher risk score may require more aggressive medical or procedural intervention.

  • Newer chest pain risk scores such as the HEART Score have been shown to better stratify risk than the TIMI Score, particularly in the undifferentiated chest pain patient.

Management

If patients are in the 0 or 1 point group, they should be further risk stratified using another risk score or one’s own institutional practices, as risk is not low enough to safely discharge from the hospital. Many guidelines recommend higher risk levels receiving more aggressive medical intervention and/or receiving early invasive management.

Critical Actions

A TIMI Risk Score of 0 does not equate to zero risk of adverse outcome.

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