TIMI risk score in unstable angina and NSTEMI

What it is

TIMI stands for Thrombolysis In Myocardial Infarction. The TIMI risk score for UA/NSTEMI is based on seven risk factors, each worth one point, and it reads in two bands: 1) low risk, a total of 0-2, medical therapy; 2) high risk, a total of 3 or more, more likely to benefit from an early invasive approach. At the time of presentation, UA and NSTEMI may be indistinguishable and can be identically managed, and cardiac troponins, whose elevated enzymes show evidence of infarction, are used to distinguish this entity from UA.

How it is diagnosed

The seven risk factors, each worth one point, are:

1. Age 65 years or over.
2. At least three risk factors for coronary artery disease, such as hypertension, diabetes, hyperlipidemia, smoking, or family history of early CAD.
3. Known coronary artery disease, taken as prior stenosis of 50% or more on angiography.
4. Use of aspirin in the past 7 days, indicating aspirin resistance or high risk.
5. Severe angina, 2 or more episodes in the past 24 hours; one page words it as more than 1 episode of rest angina in under 24 hours, which is the same count.
6. ST-segment deviation on ECG, of half a mm or more.
7. Elevated cardiac markers, that is elevated cardiac biomarkers such as troponins.