TIMI Risk Score: A simple, effective tool for initial risk assessment1
Patients with ACS who are diagnosed as having UA/NSTEMI, present with varying degrees of ischemic risk. A multivariate analysis that adjusts for several prognostic variables simultaneously provides a more accurate tool for risk stratification. In addition, the prognostic scoring system must be readily applicable using standard patient features that are part of the routine, initial medical evaluation. The TIMI risk score, developed to address this need, has been shown to predict the risk of ischemic events.
“The TIMI risk score...enables a clinician to categorize a patient’s risk of death and ischemic events at the critical initial evaluation.”1
TIMI Risk Score Predictor Variables
Because of the complex profiles of these patients, clinicians individually assess prognosis to formulate plans for treatment. The TIMI risk score may be used as a basis for therapeutic decision-making. Prognostication of patient risk allows clinicians to triage patients to the optimum location for medical care, such as the ICU vs hospital ward vs outpatient care. The TIMI risk score also helps identify patients for whom antithrombotic therapies would be especially effective, even those in whom the treatment benefit may be smaller. As demonstrated in the charts below, the TIMI risk score demonstrates that the higher the score, the greater the risk of death or ischemic events. Therefore, patients with higher risk scores may be candidates for early, aggressive treatment.
Rate of Death or MI by 14 Days
Rate of Death, MI, or Urgent Revascularization by 14 Days
The Thrombolysis in Myocardial Infarction (TIMI) IIB trial and the Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and Non–Q–Wave MI (ESSENCE) trial were two phase 3, international, randomized, double-blind studies. The patients enrolled had unstable angina/non–ST–segment elevation myocardial infarction (UA/NSTEMI) and a wide spectrum of risk for death and cardiac ischemic events. The test cohort for development of the TIMI risk score consisted of the 1957 patients assigned to receive unfractionated heparin in the TIMI IIB trial. The risk score was validated in 3 separate cohorts: the enoxaparin treatment arm from TIMI IIB (n=1953), the unfractionated heparin group from ESSENCE (n=1564), and the enoxaparin group from the ESSENCE trial (n=1607). A multivariate logistic regression model was used to assess the statistical significance of each variable for predicting the risk of cardiac events.
