TIMI Risk Score for UA/NSTEMI
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.