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    TIMI Risk Score for UA/NSTEMI

    Estimates mortality for patients with unstable angina and non-ST elevation MI.
    When to Use
    Pearls/Pitfalls
    Why Use

    Can be used to help risk stratify patients with presumed ischemic chest pain. However, it was originally derived in patients with confirmed unstable angina or non-ST elevation myocardial infarction.

    • One of the earliest chest pain decision rules that was widely implemented.

    • Originally derived with patients with known unstable angina or NSTEMI.

    • 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.
    • A TIMI risk score of 0 or 1 does not equal zero risk of adverse outcome. The original study showed 4.7% of patients with a score of 0 or 1 had adverse outcomes within 14 days. Validation studies showed 1.7 to 2.1% of patients with a score of 0 still had adverse outcomes within 30 days.

    • Unclear if this risk score can be used in patients with chest pain in the setting of cocaine use.

    • The TIMI Score was further studied as part of an accelerated diagnostic protocol in the ADAPT trial, which includes estimation of pre-test probability using TIMI, plus abnormal EKG and troponin (high-sensitivity cardiac troponin I).

    UA/NSTEMI can sometimes be missed. Traditionally, the TIMI Risk Score for UA/NSTEMI can correlate the risk of adverse outcome in chest pain patients.

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    Next Steps
    Evidence
    Creator Insights
    Dr. Elliott M. Antman

    About the Creator

    Elliott M. Antman, MD, is a professor and associate dean for Clinical/Translational Research at Harvard Medical School. He is also a senior physician in the Cardiovascular Division of the Brigham and Women's Hospital in Massachusetts and President of the American Heart Association (2014-2015). As a senior investigator in the TIMI Study Group, Dr. Antman has published on the use of serum cardiac markers for diagnosis and prognosis of patients with unstable angina and acute myocardial infarction, cyclooxygenase and cardiovascular risk, and antithrombotic therapy for acute coronary syndromes.

    To view Dr. Elliott M. Antman's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Elliott M. Antman
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