TIMI Risk Score for UA/NSTEMI
14-day risk of death, MI, or severe ischemia in non-ST-elevation ACS using 7 criteria.
About this calculator
The TIMI score predicts 14-day risk of death, recurrent MI, and need for urgent revascularization in NSTEMI and unstable angina. Developed by Antman et al. (JAMA, 2000) in TIMI 11B and ESSENCE trial patients. Seven criteria, 1 point each: age >=65, >=3 CAD risk factors, prior CAD (stenosis >=50%), ASA use in past 7 days, >=2 angina episodes in 24 hours, ST deviation >=0.5 mm, troponin elevation. Interpretation. 0-1 – low risk (14-day composite 4.7%), conservative strategy. 2 – 8.3%. 3 – 13.2%. 4 – 19.9%. 5 – 26.2%. 6-7 – 40.9%, aggressive strategy with early invasive approach. Clinical use. ACC/AHA 2022 recommend TIMI and GRACE for NSTEMI stratification. TIMI is simpler; GRACE more accurately predicts mortality. Using TIMI for time-to-angiography: TIMI >=3 plus positive troponin or dynamic ECG changes – angiography within 24-72 hours. High-risk patients with TIMI >=5 are considered for angiography within 24 hours. Dual antiplatelet therapy. TIMI guides DAPT duration after PCI: high TIMI – extend to 12-30 months (DAPT trial), low – standard 12 months. After ATLAS-ACS 2 showed benefit of low-dose rivaroxaban, high-risk patients are considered for aspirin + clopidogrel + rivaroxaban 2.5 mg twice daily. Limitations. Developed before the high-sensitivity troponin era – with hsTnI/hsTnT any significant troponin change gives 1 point on TIMI, leading to score inflation in most small-MI patients. Not used in STEMI (there is a separate TIMI STEMI score). Does not discriminate as accurately as GRACE in the very-high-risk group.
Source
Formula version: antman-2000-v1
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