View source for Thrombolysis in Myocardial Infarction risk score for unstable angina or non-ST elevation myocardial infarction

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In [[medicine]], the [http://www.timi.org/files/riskscore/risk_ua.htm Thrombolysis in Myocardial Infarction (TIMI) Risk Score for unstable angina or non-ST-elevation myocardial infarction] (NSTEMI) is a [[clinical prediction rule]] that originally was developed to predict the likelihood of morbidity in patients with [[unstable angina]] or NSTEMI.<ref name="pmid10938172">{{cite journal |author=Antman EM, Cohen M, Bernink PJ, ''et al'' |title=The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making |journal=JAMA |volume=284 |issue=7 |pages=835–42 |year=2000 |pmid=10938172 |doi=|url=http://jama.ama-assn.org/cgi/content/full/284/7/835}} [http://www.timi.org/files/riskscore/risk_ua.htm printable card]</ref>

The TIMI Risk Score for unstable angina or NSTEMI has also been used to detect patients with chest pain who are at increased risk of [[acute coronary syndrome]].<ref  name="pmid19041531">{{cite journal| author=Campbell CF, Chang AM,  Sease KL, Follansbee C, McCusker CM, Shofer FS et al.| title=Combining  Thrombolysis in Myocardial Infarction risk score and clear-cut  alternative diagnosis for chest pain risk stratification. | journal=Am J  Emerg Med | year= 2009 | volume= 27 | issue= 1 | pages= 37-42 |  pmid=19041531 |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19041531  | doi=10.1016/j.ajem.2008.01.028 }} </ref><ref name="pmid16365321">{{cite journal|  author=Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE|  title=Application of the TIMI risk score for unstable angina and non-ST  elevation acute coronary syndrome to an unselected emergency department  chest pain population. | journal=Acad Emerg Med | year= 2006 | volume=  13 | issue= 1 | pages= 13-8 | pmid=16365321 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16365321  | doi=10.1197/j.aem.2005.06.031 }} </ref> 
==Calculation==
The TIMI risk score is scored as one point for each of the following:
* Age 65 years or older
* At least 3 risk factors for coronary artery disease (family history or [[coronary heart disease]], [[hypertension]], [[hypercholesterolemia]], [[diabetes]], current smoking)
* Prior coronary stenosis of 50% or more
* ST-segment deviation on electrocardiogram at presentation
* At least 2 anginal events in prior 24 hours
* Use of aspirin in prior 7 days
* Elevated serum cardiac markers

==Interpretation==
One study found that "the incidence of 30-day death, myocardial  infarction, or revascularization for patients with a clinical impression  of an alternative diagnosis and a TIMI score of 0 was 2.9%."<ref   name="pmid19041531">{{cite journal|  author=Campbell CF, Chang AM,  Sease KL, Follansbee C, McCusker CM,  Shofer FS et al.| title=Combining  Thrombolysis in Myocardial Infarction  risk score and clear-cut  alternative diagnosis for chest pain risk  stratification. | journal=Am J  Emerg Med | year= 2009 | volume= 27 |  issue= 1 | pages= 37-42 |  pmid=19041531 |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19041531    | doi=10.1016/j.ajem.2008.01.028 }} </ref>

The risk of either death, myocardial infarction, or urgent [[myocardial revascularization]] according to the number of points:<ref name="pmid10938172"/>
* 0-1 point: 5%
* 2 points:  8%
* 3 points: 13%
* 4 points: 20%
* 5 points: 26%
* 6-7 points: 41%

Among patients with unstable angina or NSTEMI, those with a (TIMI) risk score of 3 or more may benefit from invasive management ([[PTCA]]) according to the TACTICS [[randomized controlled trial]].<ref name="pmid11419424">{{cite journal |author=Cannon CP, Weintraub WS, Demopoulos LA, ''et al'' |title=Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban |journal=N. Engl. J. Med. |volume=344 |issue=25 |pages=1879-87 |year=2001 |pmid=11419424 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11419424&promo=ONFLNS19 |issn=}}</ref>

According to [[clinical practice guideline]]s, [[percutaneous transluminal coronary angioplasty]] (PTCA) is "indicated for patients with UA/NSTEMI who have no serious comorbidity and who have coronary lesions amenable to PCI and any of the high-risk features."<ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=J. Am. Coll. Cardiol. |volume=50 |issue=7 |pages=e1–e157 |year=2007 |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013}}</ref> High-risk features is later defined at "refractory angina or hemodynamic or electrical instability" or "elevated risk for clinical events" (high [[Thrombolysis in Myocardial Infarction (TIMI) risk score]]).

==Modified Thrombolysis in Myocardial Infarction (mTIMI) risk score ==
An initial study, without external validation, suggests that the TIMI risk score can be improved by adding the variables ejection fraction < 35% and the presence of [[diabetes]].<ref>García-Almagro FJ, et al. Prognostic value of the Thrombolysis in Myocardial Infarction risk score in a unselected population with chest pain. Construction of a new predictive model. Am J Emerg Med. 2008 May;26(4):439-45. PMID 18410812</ref>

==References==
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