TIMI Risk Score (UA / NSTEMI)
Estimate 14-day risk of death, new/recurrent MI, or urgent revascularisation in unstable angina and NSTEMI. Guides early invasive strategy and choice of antithrombotic therapy.
TIMI Risk Score
0/7
Low risk — 14-day MACE risk: 4.7%
Treatment Strategy
Conservative strategy reasonable. Aspirin + clopidogrel or ticagrelor, LMWH/fondaparinux, statin, beta-blocker. Non-invasive stress testing before discharge. Re-stratify if recurrent symptoms.
From TIMI score to discharge plan in one workflow
EasyClinic links the TIMI score to your hospital's NSTEMI protocol, generates the cath lab referral, prescribes the right antithrombotic combination, and schedules cardiac rehab follow-up.
Also Known As
What is the TIMI Risk Score?
The TIMI Risk Score for UA/NSTEMI was derived from the TIMI 11B and ESSENCE trials by Antman et al. (JAMA 2000). It uses 7 simple bedside variables — each worth 1 point — to predict the 14-day composite endpoint of all-cause death, new or recurrent MI, or urgent revascularisation.
Range: 0–7. Higher scores identify patients who benefit most from an early invasive strategy and from LMWH (vs UFH) and GP IIb/IIIa inhibitors.
14-day MACE Risk by Score
- 0–1: 4.7%
- 2: 8.3%
- 3: 13.2%
- 4: 19.9%
- 5: 26.2%
- 6–7: 40.9%
Treatment Implications (Score ≥ 3)
- Early invasive strategy: Coronary angiography ≤ 24–72 h (≤ 2 h if unstable per ESC 2023).
- Anticoagulation: LMWH (enoxaparin 1 mg/kg SC BD; reduce to 0.75 mg/kg if age ≥ 75 or CrCl < 30) preferred over UFH for medical management. Fondaparinux 2.5 mg SC OD is an alternative with lowest bleeding risk.
- Antiplatelets: Aspirin 300 mg load → 75 mg OD + ticagrelor 180 mg load → 90 mg BD (preferred) or clopidogrel 300–600 mg load → 75 mg OD.
- GP IIb/IIIa: Tirofiban or eptifibatide — added at the time of PCI in high-risk patients, especially with troponin positivity.
- Statin: High-intensity (atorvastatin 80 mg or rosuvastatin 40 mg) regardless of LDL.
- Beta-blocker, ACE-I, MRA (if EF < 40%): per standard ACS bundle.
TIMI vs HEART vs GRACE
- HEART: for undifferentiated chest pain in ED — best for low-risk discharge.
- TIMI: for confirmed UA/NSTEMI — best for guiding invasive vs conservative.
- GRACE: for in-hospital and 6-month mortality after confirmed ACS — best long-term prognosis. ESC 2023 recommends GRACE ≥ 140 for early invasive strategy.
Frequently Asked Questions
▸Should I use TIMI or GRACE for invasive strategy timing?
ESC 2023 prefers GRACE ≥ 140 for the early invasive (≤ 24 h) cutoff. TIMI ≥ 3 is a simpler bedside surrogate that correlates well. Both perform similarly in head-to-head studies — use whichever your unit standardises on.
▸Does the "aspirin in past 7 days" criterion mean aspirin is harmful?
No — it is a marker of more aggressive underlying disease (the patient developed ACS despite aspirin). Aspirin remains the cornerstone of ACS therapy. The point reflects a worse prognosis cohort, not a treatment effect.
▸Is TIMI validated for the Indian population?
Yes — Indian registry data (CREATE, Kerala ACS Registry) confirm TIMI's prognostic value. Indians often present at younger age with fewer traditional risk factors but more severe disease, so do not under-stratify based on age alone.
▸What is the role of ticagrelor over clopidogrel in NSTEMI?
PLATO trial showed ticagrelor superior to clopidogrel in reducing CV death/MI/stroke in ACS. CSI and ESC prefer ticagrelor (Brilinta, generic ticagrelor) for NSTEMI unless contraindicated (active bleed, prior ICH, severe hepatic impairment, advanced AV block without pacemaker).
▸Can TIMI be used in STEMI?
No — there is a separate TIMI STEMI Risk Score (different variables: age, SBP, HR, Killip class, anterior MI/LBBB, weight, time to treatment). All STEMI patients qualify for emergent reperfusion regardless of risk score; the STEMI TIMI score is prognostic only.
References
- Antman EM et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000;284(7):835-42
- ESC Guidelines for the management of acute coronary syndromes 2023
- AHA/ACC/ACCP/HRS Guideline for the Management of Patients With Chronic Coronary Disease 2023
- Cantor WJ et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction (TRANSFER-AMI). NEJM 2009
- Cardiological Society of India (CSI) Consensus on Acute Coronary Syndrome Management
ACS risk stratification, built into the chart
EasyClinic auto-computes TIMI, HEART, and GRACE scores side-by-side for every chest pain admission — and surfaces antithrombotic protocol recommendations per CSI/ESC guidelines.
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