Medical AITIMI risk score for unstable angina / NSTEMI
A seven-item bedside score (0 to 7) for unstable angina or NSTEMI that estimates the 14-day risk of a composite of all-cause death, new or recurrent myocardial infarction, and severe recurrent ischaemia requiring urgent revascularisation. Higher scores identify patients who derive more benefit from an early invasive strategy and potent antithrombotic therapy.
How to measure each input
- Coronary risk factors
- Count family history of premature CAD, hypertension, hypercholesterolaemia, diabetes mellitus, and current smoking. Three or more scores the point.
- ST-segment deviation
- Read the presenting 12-lead ECG. Deviation of at least 0.5 mm (0.05 mV), whether transient ST elevation or ST depression, scores the point.
- Aspirin use
- Ask whether the patient was taking aspirin in the prior 7 days. Recent aspirin use scores a point because ischaemic events occurring despite it mark more aggressive disease.
- Cardiac biomarkers
- Use the institution's troponin (or CK-MB) assay. A result above the upper reference limit consistent with necrosis scores the point.
Interpretation
| Band | Meaning |
|---|---|
| 0 to 1, low risk | About 4.7% 14-day risk of the composite endpoint (all-cause death, new or recurrent MI, or severe recurrent ischaemia requiring urgent revascularisation). Lower-risk patients may be managed with an early conservative strategy in many settings. |
| 2, low to intermediate risk | About 8.3% 14-day risk of the composite endpoint. Risk rises steadily with each additional point. |
| 3 to 4, intermediate risk | About 13.2% at a score of 3 and 19.9% at 4 for the 14-day composite endpoint. These patients tend to benefit from an early invasive strategy and intensified antithrombotic therapy. |
| 5 to 7, high risk | About 26.2% at 5 and 40.9% at 6 to 7 for the 14-day composite endpoint. High-risk patients generally warrant an early invasive strategy and potent antithrombotic therapy unless contraindicated. |
Pitfalls, exclusions and caveats
- Derived and validated in unstable angina and NSTEMI. It is not intended for ST-elevation MI, which has its own TIMI risk score.
- It is a risk-stratification aid that informs the intensity of therapy and the case for an early invasive strategy. It is not a stand-alone treatment rule or a discharge tool.
- Equal weighting means a troponin-positive patient and a patient who simply has multiple risk factors can share a score, yet differ clinically. Interpret the number alongside the whole presentation.
- The quoted event rates are from the original derivation cohorts (TIMI 11B and ESSENCE). Absolute rates in a contemporary, heavily revascularised population may differ.
1 point each: age >= 65 years + at least 3 coronary risk factors + known coronary stenosis >= 50% + ST-segment deviation >= 0.5 mm on the presenting ECG + at least 2 anginal episodes in the prior 24 hours + aspirin use in the prior 7 days + elevated cardiac biomarkers. Total 0 to 7.The TIMI risk score for unstable angina/NSTEMI was described by Antman et al. (2000). This implementation is an educational tool and is not affiliated with the original authors or the TIMI Study Group.
Frequently asked
What does the TIMI UA/NSTEMI score predict?
The 14-day risk of a composite endpoint: all-cause mortality, new or recurrent myocardial infarction, and severe recurrent ischaemia requiring urgent revascularisation. The composite rate rises from about 4.7% at a score of 0 to 1 up to about 40.9% at 6 to 7.
Why does aspirin use add a point rather than removing one?
Recent aspirin use is a marker of more aggressive disease: a patient who develops an acute coronary syndrome despite taking aspirin tends to be at higher risk, so the item adds a point.
Can I use this score for a STEMI patient?
No. This score was derived in unstable angina and NSTEMI. ST-elevation MI has a separate TIMI risk score and a different management pathway centred on prompt reperfusion.
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