Thrombolysis in Myocardial Infarction risk score for unstable angina or non-ST elevation myocardial infarction: Difference between revisions
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In medicine, the Thrombolysis in Myocardial Infarction (TIMI) Risk Score is a clinical prediction rule that can predict the likelihood of morbidity in patients with unstable angina or non-ST-elevation myocardial infarction.[1]
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
The risk of either death, myocardial infarction, or urgent myocardial revascularization according to the number of points:[1]
- 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.[2]
According to clinical practice guidelines, 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."[3] 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.[4]
References
- ↑ 1.0 1.1 Antman EM, Cohen M, Bernink PJ, et al (2000). "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making". JAMA 284 (7): 835–42. PMID 10938172. [e] printable card
- ↑ Cannon CP, Weintraub WS, Demopoulos LA, et al (2001). "Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban". N. Engl. J. Med. 344 (25): 1879-87. PMID 11419424. [e]
- ↑ Anderson JL, Adams CD, Antman EM, et al (2007). "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". J. Am. Coll. Cardiol. 50 (7): e1–e157. DOI:10.1016/j.jacc.2007.02.013. PMID 17692738. Research Blogging.
- ↑ 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