Mortality risk in non-ST elevation ACS
Total Score
Low Risk (5-8% all-cause mortality, MI, or severe ischemia at 14 days).
Disclaimer: The clinical scoring and algorithms on this platform are intended strictly for professional informational purposes. They do not constitute a definitive medical diagnosis, treatment, or clinical decision. The final judgment and responsibility lie with the treating physician.
Yasal Uyarı: Bu platformdaki klinik skorlamalar ve algoritmalar yalnızca sağlık profesyonellerini bilgilendirme amaçlıdır. Herhangi bir kesin tıbbi teşhis, tedavi veya klinik karar yerine geçemez. Nihai karar ve sorumluluk hastayı yatak başında değerlendiren hekime aittir.
The TIMI (Thrombolysis in Myocardial Infarction) Risk Score for Unstable Angina/NSTEMI predicts the 14-day risk of all-cause mortality, new myocardial infarction, or severe recurrent ischemia prompting urgent revascularization. It is a critical triage tool for determining whether an early invasive strategy (angiography) is warranted.
Aspirin use within the last 7 days indicates plaque rupture or thrombosis despite antiplatelet therapy, thereby adding a point to the score. Even a seemingly 'low risk' TIMI score requires clinical judgment, as GRACE scores are often preferred for more precise in-hospital mortality estimation.
Antman EM, Cohen M, Bernink PJ, 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.
Disclaimer: The clinical scoring and algorithms on this platform are intended strictly for professional informational purposes. They do not constitute a definitive medical diagnosis, treatment, or clinical decision. The final judgment and responsibility lie with the treating physician.
Apply the TIMI UA/NSTEMI Score to patients with confirmed or suspected non-ST-elevation ACS (NSTEMI or unstable angina). The score predicts 14-day risk of all-cause mortality, new/recurrent MI, or severe ischemia requiring urgent revascularization. Scores ≥ 3 identify patients who derive significant benefit from early invasive catheterization and glycoprotein IIb/IIIa inhibitors. Do not apply this score to STEMI patients — use the TIMI STEMI Score for those. The score requires confirmation that ST deviation is ≥ 0.5 mm on ECG and that troponin elevations are present (not just suspected).
The 'aspirin use in the prior 7 days' criterion is paradoxical — it scores 1 point and increases risk because aspirin-refractory chest pain indicates platelet aggregation through aspirin-insensitive pathways (e.g., ADP-mediated), signalling a more aggressive thrombotic process. This makes it a useful clinical marker even if non-intuitive. Also notable: known CAD (stenosis ≥ 50%) adds 1 point regardless of whether it has been revascularized — a patient with a prior CABG or PCI still qualifies.
The 7-point TIMI UA/NSTEMI score was derived from the TIMI 11B trial population, which may not reflect contemporary ED patients or those presenting with highly sensitive troponin assays. In current practice, the GRACE score and HEART score are often preferred for their stronger predictive accuracy across diverse populations. The TIMI risk stratification thresholds (low 0–2, intermediate 3–4, high 5–7) should always be interpreted in the context of patient-specific factors such as renal function, bleeding risk, and clinical stability before escalating to invasive strategies.