TIMI Risk Score
Info
Age>65 years Yes No
Greater than or equal to 3 cardiac risk factors* No Yes
ST Deviation No Yes
Aspirin use in last 7 days No Yes
Greater than or equal to 2 anginal events in past 24 hrs No Yes
Elevated Troponin No Yes
Established CAD No Yes
R e s u l t s
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TIMI Risk Score

The Thrombolysis in Myocardial Infarction (TIMI) risk score applied to outcomes in unstable angina/non-ST-segment elevation myocardial infarction (MI) (UA/NSTEMI) was published in JAMA in 2000.

This tool is meant for use in patients presenting with either unstable angina or non-ST-segment elevation myocardial infarction.

This tool reports risk of developing at least 1 of the following adverse events (between 0-14 days of presentation):

  • All cause mortality
  • New or recurrent MI
  • Severe recurrent ischemia requiring urgent revascularization

Data from patients in the ESSENCE and TIMI 11B trial were utilized to generate this tool. Two subgroups made up the entire dataset; those who were treated with unfractionated heparin (UH) and those treated with the low molecular weight heparin, enoxaparin. Outcomes are reported depending upon whether UH or enoxaparin was utilized (less adverse events in all categories with use of enoxaparin).

7 items make up this TIMI Risk Score, with the TIMI Score being the sum of all items (range 0-7 points).

Elements of the TIMI Risk Score

  • Age
    • >=65 years [1 pts]
    • <65 years [0 pt]
  • At least 3 risk factors for CAD from(Family history of CAD, Hypertension, Current Smoker, Hypercholesterolemia, Diabetes)
    • Yes [1 pt]
    • No [0 pt]
  • Significant Coronary Stenosis(Prior Coronary Stenosis >=50%)
    • Yes [1 pt]
    • No [0 pt]
  • ST Deviation (>=0.5 mm)
    • Yes [1 pt]
    • No [0 pt]
  • Severe Anginal Symptoms (>=2 Anginal events in last 24 hrs)
    • Yes [1 pt]
    • No [0 pt]
  • Use of Aspirin in last 7 Days
    • Yes [1 pt]
    • No [0 pt]
  • Elevated Serum Cardiac Markers (CKMB &/or Troponin)
    • Yes [1 pt]
    • No [0 pt]
TIMI Score Rate of composite endpoint (%) for treatment with Enoxaparin Rate of composite endpoint (%) for treatment with Unfractionated Heparin
0/1 6.3 6.6
2 9.2 10.7
3 12.5 15.1
4 12.8 17.5
5 18.7 29.8
6/7 22.1 38.7

The rate of composite endpoint [death, new or recurrent MI or urgent revascularization] is from the combined weighted data of both TIMI 11B and ESSCENCE trials.

Data UH (TIMI 11B)

TIMI Score All Cause Mortality (%) Myocardial Infarction Urgent Revascularization All cause mortality or nonfatal MI
0/1 0 3.5 1.2 3.5
2 0.9 1.8 6.2 2.4
3 1.8 4.0 9.1 4.8
4 2.6 5.9 14.0 7.5
5 7.1 9.7 15.0 13.5
6/7 10.6 16.7 27.3 22.7

Data Enoxaparin (TIMI 11B)

TIMI Score All Cause Mortality (%) Myocardial Infarction Urgent Revascularization All cause mortality or nonfatal MI
0/1 2.3 1.2 1.2 2.3
2 1.1 2.5 5.8 3.3
3 1.7 3.3 10.0 4.6
4 2.4 4.1 10.3 5.8
5 4.2 7.2 13.6 9.4
6/7 2.7 15.1 15.1 16.4

References:

  1. Antman EM, Cohen M, Bernink PJ, et al. The TIMI Risk Score for Unstable Angina/Non-ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making. JAMA . 2000 Aug 16;284(7):835-42
  2. 2. Demers C. ESSENCE trial results: breaking new ground. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events. Can J Cardiol. 1998 Aug;14 Sppl E:15E-19E.