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Abdul Wadud
May 4, 2014
Unstable angina
"Last updated:"Thursday, September 18, 2014
TIMI (Thrombolysis In Myocardial Infarction) score is used in patients with NSTEMI (Non ST-segment
elevation myocardial infarction), STEMI (ST-segment elevation myocardial infarction) and unstable
angina to define risk. TIMI Study Group established this risk score. TIMI Study Group is an Academic
Research Organization affiliated with Harvard Medical School, and Brigham and Women’s Hospital in
Boston. This score was derived from patients enlisted to randomized controlled trials of low molecular
weight heparins. The main advantages of TIMI score are its simplicity and ease of use.
1. Age of patient:
65 years or more 1
50% or more 1
It includes horizontal ST-segment depression or transient ST-segment elevation more than 1 mm.
Absent 0
Present 1
Absent 0
Present 1
Total score Rate of death, or new or recurrent myocardial infarction, or severe recurrent
anginal chest pain requiring urgent revascularization in 14 days
0–1 4.7%
2 8.3%
3 13.2%
4 19.9%
5 26.2%
6–7 40.9%
1. Age of patient:
65 – 74 years 2
75 years or more 3
Absent 0
Present 1
Absent 0
Present 1
4. History of diabetes:
Absent 0
Present 1
100 mg Hg or more 0
6. Heart rate:
Heart rate Score
7. Killip class:
I – No heart failure. 0
IV – Cardiogenic shock 2
8. Weight of patient:
Less than 67 kg 0
67 kg or more 1
It can be detected in ECG that shows ST segment elevation and pathological Q wave formation in
leads V1-V6.
No 0
Yes 1
Absent 0
Present 1
4 hours or more 1
Risk of death at 30
Total score
days
0 0.8%
1 1.6%
2 2.2%
3 4.4%
4 7.3%
5 12.4%
6 16.1%
7 23.4%
8 26.8%
9 – 16 35.9%
Example for patient with STEMI:
A male patient with STEMI is 70 years of age, who has no history of anginal chest pain, hypertension
and diabetes, his systolic blood pressure is 110 mg Hg and heart rate is 95 beats/minute, has a Killip
class ll, weight 70 kg, has no anterior myocardial infarction or left bundle branch block in ECG and he
treated within 4 hours of attack. His TIMI score would be: 2 + 0 + 0 + 0 + 0 + 0 + 0 + 1 + 0 + 0 + 0 = 3.
He has about a 4.4% risk of death at 30 days.