Cardiology

TIMI Risk Score (UA/NSTEMI)

7-point risk score for unstable angina and NSTEMI. Predicts 14-day all-cause mortality, new MI, and urgent revascularisation. Guides early invasive versus conservative management per ACC/AHA guidelines.

Antman et al. 2000 14-day event prediction PDF export

TIMI Criteria (UA/NSTEMI)

Age ≥ 65 years

Patient is 65 years of age or older

≥ 3 CAD risk factors

Family history of CAD, hypertension, hypercholesterolaemia, diabetes, or active smoker

Prior coronary stenosis ≥ 50%

Known CAD on prior angiography

ST deviation on ECG ≥ 0.5 mm

New ST depression or transient ST elevation on presenting ECG

≥ 2 anginal events in past 24 hours

At least 2 ischaemic events in the 24 hours before presentation

Aspirin use in past 7 days

Indicates aspirin-resistant or more severe disease

Elevated serum cardiac markers

Troponin I, troponin T, or CK-MB above upper limit of normal

TIMI Result

out of 7

14-day all-cause mortality / MI / urgent revascularisation

Risk stratification:

0-2

Low risk

~5% 14-day events

3-4

Intermediate

~13% 14-day events

5-7

High risk

~26% 14-day events

TIMI Risk Score for UA/NSTEMI

The Thrombolysis in Myocardial Infarction (TIMI) Risk Score was published by Antman et al. in 2000. It assigns one point for each of 7 predictors of 14-day adverse outcomes in confirmed unstable angina or NSTEMI.

Event rate by score

Score	14-Day Event Rate	Strategy
0-1	~5%	Conservative
2	~8%	Conservative (monitor closely)
3	~13%	Early invasive acceptable
4	~20%	Early invasive recommended
5	~26%	Urgent early invasive
6-7	~41%	Urgent angiography within 2-24h

TIMI vs HEART Score

HEART Score is for undifferentiated chest pain in the ED, before ACS is confirmed. TIMI is for patients with a confirmed UA or NSTEMI diagnosis, guiding the next decision: invasive or conservative. Use HEART first, TIMI after confirmation.

Related tools

For undifferentiated chest pain triage, see HEART Score. For 10-year CVD risk, see Framingham Risk Score. For QTc monitoring during antiarrhythmic therapy, see QTc Calculator. For AF stroke risk, see CHA2DS2-VASc Score. For renal dosing of anticoagulants, see Creatinine Clearance. For DVT/PE, see Wells Score.

References

Antman EM, et al. "The TIMI risk score for unstable angina/non-ST elevation MI." JAMA. 2000;284(7):835-842.
Amsterdam EA, et al. "2014 AHA/ACC Guideline for NSTE-ACS." JACC. 2014;64(24):e139-228.

Clinical note: TIMI is a risk stratification tool, not a diagnosis. All management decisions require comprehensive clinical assessment and cardiologist input.