What is the TIMI score?

The TIMI (Thrombolysis in Myocardial Infarction) risk score predicts 14-day mortality, new or recurrent MI, or severe ischemia requiring revascularization in patients with unstable angina or NSTEMI. Seven risk factors are assessed, each scoring 1 point: age ≥ 65, ≥ 3 CAD risk factors, known coronary stenosis ≥ 50%, ST deviation, ≥ 2 anginal events in 24h, aspirin use in past 7 days, and elevated cardiac markers.

How is the TIMI score interpreted?

Score 0–1: ~5% risk of adverse events (low risk). Score 2: ~8%. Score 3: ~13%. Score 4: ~20%. Score 5: ~26%. Score 6–7: ~41%. Higher scores indicate benefit from early invasive management (cardiac catheterization) over conservative strategy.

When should the TIMI score be used?

TIMI should be used in patients with confirmed unstable angina or NSTEMI to guide treatment intensity and timing of invasive strategy. It is NOT designed for undifferentiated chest pain in the ED — use the HEART score for that purpose. TIMI should not be applied to STEMI patients, who require immediate reperfusion.

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TIMI-Risikoscore für NSTEMI/UA

Estimate 14-day risk of death, MI, or urgent revascularization in patients with NSTEMI or unstable angina. Score range: 0–7.

Criteria (1 point each)

Age ≥ 65 years ≥ 3 CAD risk factors (FHx, HTN, DM, smoking, hyperlipidemia) Known CAD (stenosis ≥ 50%) ASA use in past 7 days Severe angina (≥ 2 episodes in 24h) ST deviation ≥ 0.5 mm on ECG Elevated cardiac biomarkers (troponin)

14-day event rate: ~5%

0–1~5% event rate

2~8% event rate

3~13% event rate

4~20% event rate

5~26% event rate

6–7~41% event rate

Disclaimer: Nur zu Bildungszwecken. Kein Ersatz für klinisches Urteilsvermögen.

Anwendung

Use the TIMI Risk Score for NSTEMI/UA in patients presenting to the ED with chest pain and suspected ACS who do not have STEMI on ECG. Helps guide decisions about invasive vs. conservative management.

Klinische Praxistipps

TIMI ≥ 3 generally favors early invasive strategy (angiography within 24–72h).
The "ASA use" criterion is a marker of known vascular disease, not a treatment effect.
This is the NSTEMI/UA version — a separate TIMI risk score exists for STEMI.
HEART score may perform better in undifferentiated ED chest pain; TIMI is better validated in confirmed ACS.

References

Antman EM, et al. The TIMI risk score for unstable angina/non-ST elevation MI. JAMA. 2000;284(7):835-842.

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Über dieses Tool

What Is the TIMI Risk Score?

The TIMI (Thrombolysis in Myocardial Infarction) Risk Score for NSTEMI/Unstable Angina is a validated clinical prediction tool that estimates the 14-day risk of all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization. Developed by Antman et al. in 2000 from the TIMI 11B trial population, the score uses seven equally weighted clinical variables, each contributing one point for a total range of 0–7.

Components and Scoring

The seven criteria are: age ≥ 65 years, ≥ 3 coronary artery disease risk factors, known coronary artery disease (≥ 50% stenosis), aspirin use in the past 7 days (as a marker of known vascular disease), severe angina (≥ 2 episodes in 24 hours), ST-segment deviation ≥ 0.5 mm on presenting ECG, and elevated cardiac biomarkers (troponin). Each criterion scores 1 point when present, creating a simple additive score that can be calculated at the bedside without a calculator.

Clinical Application

The TIMI score stratifies patients into risk categories that guide management intensity. Low-risk patients (0–2) may be appropriate for conservative management with medical therapy and possible outpatient stress testing. Intermediate and high-risk patients (≥ 3) typically benefit from an early invasive strategy with coronary angiography within 24–72 hours, as demonstrated in trials like TACTICS-TIMI 18. The score helps facilitate risk communication between clinicians and supports evidence-based triage decisions in the acute care setting.

🔑 Klinische Praxistipps

TIMI ≥ 3 generally favors early invasive strategy per ACC/AHA guidelines for NSTE-ACS.
The score was derived and validated in patients with confirmed ACS — it is NOT designed for undifferentiated chest pain (use HEART score for that).
Event rates increase progressively: 0–1 = ~5%, 2 = ~8%, 3 = ~13%, 4 = ~20%, 5 = ~26%, 6–7 = ~41%.
Troponin elevation alone scores 1 point — but high-sensitivity troponin has changed the landscape since the score was developed.

Key References

Antman EM, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-842.
Cannon CP, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban (TACTICS-TIMI 18). N Engl J Med. 2001;344(25):1879-1887.

Formel zuletzt überprüft: Februar 2026