Thrombolysis in myocardial infarction (TIMI) risk score

Last revised by Bahman Rasuli on 14 Mar 2021

The thrombolysis in myocardial infarction (TIMI) risk score is a prognostic risk stratification system that categorizes the risk of death and ischemic events in patients with unstable angina / non-ST elevation myocardial infarction and provides a basis for therapeutic decision making. It is thought to have potential to improve the management of patients presenting to hospital with undifferentiated chest pain where ischemic heart disease is a potential diagnosis 3.

Score calculation

One point is given for each:

  • age ≥65 years
  • aspirin use within the last 7 days (patient has chest pain despite as required use in past 7 days)
  • at least 2 angina episodes in the last 24 hours
  • ST changes of at least 0.5 mm in contiguous leads
  • elevated serum cardiac biomarkers
  • known coronary artery disease (CAD) (coronary stenosis ≥50%)
  • at least 3 risk factors for coronary artery disease, which include:
    • hypertension >140/90 mmHg or on anti-hypertensives
    • current cigarette smoking 
    • low HDL cholesterol (<40 mg/dL)
    • diabetes mellitus
    • family history of premature coronary artery disease
      • male first-degree relative or father younger than 55 years
      • female first-degree relative or mother younger than 65 years
Score interpretation

A percentage risk at 14 days of all-cause mortality, new or recurrent myocardial infarction, or severe recurrent ischemia requiring urgent revascularization.

The predicted risk is as follows 4:

  • score of 0-1 = 4.7% risk
  • score of 2 = 8.3% risk
  • score of 3 = 13.2% risk
  • score of 4 = 19.9% risk
  • score of 5 = 26.2% risk
  • score of 6-7 = at least 40.9% risk

See also

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