TIMI risk score

Features identifying low-, moderate-, and high-risk NSTE ACS patients are described using the thrombolysis in myocardial infarction (TIMI) risk score in Table 5-1.13... 

TABLE 5-1. TIMI Risk Score for Non-ST-Segment Elevation Acute Coronary Syndromes2 17... 

Use of aspirin within the past 7 days Using the TIMI Risk Score One point is assigned for each of the seven medical history and... 

TIMI risk score TIMI risk score TIMI risk score... 

Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST-segment elevation MI a method for prognostication and therapeutic decision-making. JAMA 2000 284 835-842. 

Patients with NSTE ACS who are considered to be at low risk (based on TIMI risk score) should have serial biochemical markers obtained. If they are negative, the patient may be admitted to a general medical floor with ECG telemetry monitoring, undergo a noninvasive stress test, or may be discharged. 

Antman developed a thrombosis in myocardial infarction (TIMI) risk score based on a database of 15,078 patients with STEMI or new onset of complete left bundle branch block (8), The score was validated in the TIMI 9 data set. Ten characteristics of these patients accounted for 97% of the predictive capacity of their multivariate model. These are included in the risk score (Table I). Points were given for difference parameters as listed in Table I. The risk score had a strong association with 30-day mortality. There was a greater >40-fold increase in mortality from TIMI risk score 0 to >8 at 30 days (Table I) (8), The TIMI risk score is easy to apply and can be done at the bedside. 

T ble 1 TIMI risk score for ST-segment elevation myocardial infarction ... 

Morrow DA, Antman EM, Charlesworth A, et al. The TIMI risk score for ST elevation myocardial infarction a convenient bedside clinical score for risk assessment at presentation. Circulation 2000 102 203 I -2037. 

Because of its great value in risk stratification, ST/T changes are part of the most frequently used risk scores (TIMI risk score) (see Risk stratification ) (p. 257). 

In STE-ACS the TIMI risk score is most commonly used (Morrow et al., 2000a,b). This score is formed by seven variables that may be easily obtained, including history taking, ECG changes,... 

Figure 8.37 (A) TIMI risk score for STE-ACS for predicting 30-day mortality (Morrow et al., 2000a,b). (B) Rates of all-case mortality, myocardial infarction and severe recurrent ischaemia prompting urgent revascularisation through 14 days after randomisation were calculated for...

Also in NSTE-ACS the TIMI risk score is the most used score (Antman et al., 2000) because it is easy to assess and combines the same variables used for cases with ST-segment elevation. Its use provides prognostic information at the short and long term (14 days and 6 months) of patients with NSTE-ACS... 

A low-risk score in both ACS with and without ST-segment elevation, according to the TIMI risk score (0-1 points) andtheTRIindex(<20) (Figures 8.37 and 8.38) is predictive of in-hospital mortality lower than 3%. All other parameters (clinical, ECG and enzymatic) may help to stratify subgroup of even a lower risk. 

The aforementioned risk scores present intermediate values (TIMI risk score of 3/4 and TRI index between 30 and 50) (Figures 8.37 and 8.38). 

Three key features identifying high-risk patients with non- ST-segment-elevation ACS are a Thrombolysis in Myocardial Infarction (TIMI) risk score of 5 to 7, the presence of ST-segment depression on ECG, and positive CK MB or troponin. 

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