TIMI Risk Score for STEMI
A patient with an STEMI who is post-cath may have bleeding risks and the primary team would like to help objectify risk-benefit of post-PCI medications.
- Obviously patients with STEMI are already at high risk for complication and bad outcome, including death.
- The TIMI Risk Score for STEMI may help a cardiology, medical and/or intensive care team with weighing risk/benefit of medications (like anticoagulation) and invasive procedures by knowing a patient’s baseline risk.
- This score was developed based on thrombolytic outcomes, which likely have worse outcomes when compared to PCI.
- Should be used in patients with diagnosed STEMI, NOT to evaluate patients with chest pain.
Studies on clinician gestalt estimating mortality and complication risk often underestimate risk, and guidelines recommend higher risk patients receiving more aggressive medical interventions.
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STEMI patients should obviously undergo PCI or thrombolysis, depending on availability and standard of care at one’s hospital; risk stratification can be performed after this most critical first step.
Addition of the assigned points.
Facts & Figures
|Age < 65 years||0|
|Age ≥ 75||+3|
|DM or Hypertension or Angina||+1|
|Systolic BP < 100 mmHg||+3|
|Heart Rate > 100||+2|
|Killip Class II-IV||+2|
|Weight < 67kg (147.7 lbs)||+1|
|Anterior ST Elevation or LBBB||+1|
|Time to Treatment > 4 hours||+1|
- The TIMI Score for STEMI was developed from the InTIME II trial of 15,000 STEMI patients and was studying these patients for thrombolytics
- It did not include patients with cardiogenic shock nor severe hypertension (> 180/>110)
- Its primary endpoint was 30-day all-cause mortality and did not include a placebo arm
- Because it was a thrombolytics trial, it obviously did not include patients undergoing percutaenous coronary intervention (PCI), which provides better outcomes when readily available.
- This score also included patients with left bundle branch block, which was thought to be a STEMI equivalent; a new left bundle is no longer considered to be a “STEMI equivalent” especially considering Sgarbossa Criteria.
Original/Primary ReferenceDavid A. Morrow, et. al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy Circulation. 2000; 102: 2031-2037 doi: 10.1161/01.CIR.102.17.2031
ValidationMorrow DA, Antman EM, Parsons L, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA. 2001;286(11):1356-9.Bradshaw PJ, Ko DT, Newman AM, Donovan LR, Tu JV. Validation of the Thrombolysis In Myocardial Infarction (TIMI) risk index for predicting early mortality in a population-based cohort of STEMI and non-STEMI patients. Can J Cardiol. 2007;23(1):51-6.Silveira DS, Jaeger CP et al. Validation of TIMI risk score for STEMI. International Journal of Cardiovascular Sciences. 2016;29(3):189-197.
About the Creator
David A. Morrow, MD, MPH, is an associate professor at Harvard Medical School and the director of the Samuel A. Levine Cardiac Unit at Brigham and Women's Hospital in Massachusetts. He is a senior investigator in the TIMI Study Group with a research focus in the management of unstable and stable coronary artery disease, and he directs the TIMI Biomarker Program. Dr. Morrow has more than 150 publications in areas such as risk stratification in patients with ischemic heart disease.
To view Dr. David A. Morrow's publications, visit PubMed