What the TIMI score is for
When a patient arrives with chest pain from unstable angina or a non-ST-elevation myocardial infarction (NSTEMI), doctors need to know quickly who is at high risk. The TIMI risk score, published in 2000 by the Thrombolysis in Myocardial Infarction study group, uses seven simple criteria available at the bedside.
The seven criteria
Each criterion present scores 1 point, for a total from 0 to 7:
- Age 65 or older.
- Three or more coronary risk factors: family history of coronary disease, high blood pressure, high cholesterol, diabetes, current smoking.
- Known coronary stenosis of 50% or more.
- Aspirin use in the past 7 days.
- Two or more angina episodes in the past 24 hours.
- ST deviation of 0.5 mm or more on the ECG.
- A raised cardiac marker such as troponin.
Risk by score
In the original study, the 14-day risk of death, new or recurrent heart attack, or severe recurrent ischemia needing urgent revascularization was:
| TIMI score | 14-day risk |
|---|---|
| 0 to 1 | 4.7% |
| 2 | 8.3% |
| 3 | 13.2% |
| 4 | 19.9% |
| 5 | 26.2% |
| 6 to 7 | 40.9% |
Worked example
A 70-year-old patient with a raised troponin and none of the other criteria scores 2 points, with an estimated 14-day event risk of 8.3%.
How it is used
A higher score has been associated with greater benefit from an early invasive strategy (coronary angiography) and more intensive antithrombotic treatment. It is quick to calculate and needs no laboratory values beyond the cardiac markers.
Limits
- The score was derived from clinical trial patients, who may differ from those seen in everyday practice.
- It gives equal weight to each criterion; the aspirin criterion, for example, mostly reflects known heart disease.
- Many guidelines, including those of the European Society of Cardiology, favor the GRACE score, which uses continuous variables and predicts mortality more precisely.
- For undifferentiated chest pain in the emergency department, the HEART score is often preferred.
- A separate TIMI score exists for STEMI.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.