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The thrombolysis in myocardial infarction risk score in unstable angina/non–ST-segment elevation myocardial infarction

^* TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

Manuscript received May 7, 2002; revised manuscript received October 7, 2002, accepted December 18, 2002.

^* Reprint requests and correspondence: Dr. Marc S. Sabatine, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.
msabatine{at}partners.org

Risk stratification in unstable angina (UA)/non–ST-segment elevation myocardial infarction (NSTEMI) can provide an estimate of a patient’s prognosis and optimize clinical choices. The Thrombolysis In Myocardial Infarction (TIMI) risk score for UA/NSTEMI is an integrated approach that uses baseline variables that are part of the routine medical evaluation to identify patients at high risk for death and other major cardiac ischemic events. Using multivariable logistic regression, seven independent predictor variables were identified: age 65 years, 3 risk factors for coronary artery disease (CAD), known CAD (stenosis 50%), severe anginal symptoms (2 anginal events in preceding 24 h), use of aspirin in the last seven days, ST-segment deviation 0.05 mV, and elevated serum cardiac markers of necrosis. Each predictor carried similar prognostic weight; therefore, a risk score was constructed as the simple arithmetic sum of the number of predictors. The rate of death, MI, or urgent revascularization significantly increased as the TIMI risk score increased, ranging from <5% for patients with a risk score of 0 or 1 to >40% for patients with a risk score of 6 or 7. The risk score has been validated in several other trials of UA/NSTEMI. In addition, using the risk score to categorize patients also effectively defines a gradient for benefit with specific treatments such as low-molecular-weight heparins, glycoprotein IIb/IIIa inhibitors, and an early invasive strategy.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   CK-MB = creatine kinase-MB isoenzyme   cTn = cardiac troponin   ECG = electrocardiogram/electrocardiographic   GP = glycoprotein   LMWH = low-molecular-weight heparin   NSTEMI = non–ST-segment elevation myocardial infarction   RR = relative risk   UA = unstable angina   UFH = unfractionated heparin

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