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-days 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 Scores for NSTE-ACS (NSTEMI, UA) and STE-ACS (STEMI) can be calculated below.
TIMI risk score for NSTEMI and unstable angina
| 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% |
TIMI risk score for STEMI
| Poäng | 30-dagars mortalitet |
|---|---|
| 0 | 0,8% |
| 1 | 1,6% |
| 2 | 2,2% |
| 3 | 4,4% |
| 4 | 7,3% |
| 5 | 12,4% |
| 6 | 16,1% |
| 7 | 23,4% |
| 8 | 26,8% |
| 9-14 | 35,9% |
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.
