All patients with NSTE-ACS (NSTEMI or unstable angina) are treated similarly with respect to anti-ischemic and anti-thrombotic drugs. Management must, however, be individualized with respect to the delay to coronary angiography (PCI). The majority of patients should undergo angiography within 24 hours, but high-risk patients should be evaluated with angiography earlier. Guidelines recommend the use of validated risk models to estimate the risk of acute myocardial infarction, 30-day and 1-year mortality in patients with NSTE-ACS. TIMI, GRACE and PURSUIT are such risk models. The higher the estimated risk, the earlier should angiography be performed.
TIMI risk score for NSTEMI and unstable angina
TIMI Risk Score for NSTEMI/Unstable Angina Calculator
TIMI SCORE | 30-days mortality | 30-days acute MI | Probability of revascularization |
---|---|---|---|
0-1 | 1,2% | 2,3% | 1,2% |
2 | 1,0% | 2,1% | 6,0% |
3 | 1,7% | 3,7% | 9,5% |
4 | 2,5% | 5,0% | 12,2% |
5 | 5,6% | 8,5% | 14,3% |
6-7 | 6,5% | 15,8% | 20,9% |
References
- Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, Giugliano RP, McCabe CH, Braunwald E. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000 Oct 24;102(17):2031-7.
- The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making E M Antman, M Cohen, P J Bernink, C H McCabe, T Horacek, G Papuchis, B Mautner, R Corbalan, D Radley, E Braunwald.