14-day death / MI / urgent revascularization risk in UA/NSTEMI

What it is and when to use it

The TIMI Risk Score for unstable angina / NSTEMI estimates the risk of adverse events at 14 days in patients with non-ST-elevation acute coronary syndrome. It awards 1 point for each of 7 criteria: age ≥65 years, ≥3 coronary artery disease risk factors, known coronary disease (stenosis ≥50%), aspirin use in the prior 7 days, ≥2 anginal episodes in 24 hours, ST-segment deviation ≥0.5 mm, and elevated cardiac biomarkers. It was derived from the TIMI 11B and ESSENCE trials (Antman et al., 2000) and is recognized by the ESC and ACC/AHA guidelines as a risk-stratification tool in NSTE-ACS.

How to interpret it

The score ranges from 0 to 7. It estimates the 14-day composite risk of all-cause death, new or recurrent myocardial infarction, and severe recurrent ischemia requiring urgent revascularization. Risk rises continuously: 0–2 points reflect low risk (about 5–8%), 3–4 points intermediate risk (roughly 13–20%), and 5–7 points high risk (up to about 40% at a score of 6–7). A higher score supports an early invasive strategy and more intensive antithrombotic therapy.

Limitations and when not to use it

It was validated in patients with unstable angina or NSTEMI; it does not apply to STEMI or to undifferentiated chest pain in the emergency department, where tools such as HEART are preferable. It is a population-level risk-stratification tool, not a diagnostic rule-out: a low score does not safely exclude acute coronary syndrome and must not replace clinical judgment, serial troponins, or the ECG. It does not assess bleeding risk and does not by itself guide anticoagulant dosing.

Frequently asked questions

What are the 7 variables in the TIMI Risk Score for UA/NSTEMI?

Age ≥65 years, ≥3 coronary risk factors, known coronary disease (≥50% stenosis), aspirin use in the prior 7 days, ≥2 anginal episodes in 24 h, ST-segment deviation ≥0.5 mm, and positive cardiac biomarkers. Each criterion scores 1 point.

What TIMI score is considered high risk?

A score of 5 to 7 indicates high risk of adverse events at 14 days and supports an early invasive strategy; 0–2 is considered low risk and 3–4 intermediate risk.

What is the difference between the TIMI and GRACE scores?

Both stratify risk in NSTE-ACS, but GRACE incorporates continuous variables (heart rate, blood pressure, creatinine, Killip class) and offers superior discrimination for mortality; TIMI is simpler and faster to apply at the bedside.