TIMI Risk Score for UA/NSTEMI - MDCalc

TIMI Risk Score for UA/NSTEMI · One of the earliest chest pain decision rules that was widely implemented. · Originally derived with patients with known unstable ... Thisisanunprecedentedtime.Itisthededicationofhealthcareworkersthatwillleadusthroughthiscrisis.Thankyouforeverythingyoudo.COVID-19ResourceCenterCalcFunctionCalcsthathelppredictprobabilityofadiseaseDiagnosisSubcategoryof'Diagnosis'designedtobeverysensitiveRuleOutDiseaseisdiagnosed:prognosticatetoguidetreatmentPrognosisNumericalinputsandoutputsFormulaMedtreatmentandmoreTreatmentSuggestedprotocolsAlgorithmDiseaseSelect...SpecialtySelect...ChiefComplaintSelect...OrganSystemSelect...PatentPendingLogInEmailAddressPasswordShowForgotyourpassword?LogInOrcreateanewaccount(it'sfree)ForgotPassword?EmailAddressEnteryouremailaddressandwe'llsendyoualinktoresetyourpassword.GetNewPasswordSignInRequiredTosavefavorites,youmustlogin.Creatinganaccountisfree,easy,andtakesabout60seconds.LogInCreateAccountAlreadyhaveanMDCalcaccount?LogintolinkyourfavoritesandrecentlyusedcalcsEmailAddressPasswordShowForgotyourpassword?LogInOrcontinuetoNuanceAttentionCOACHSTUDYparticipants:Theprincipalinvestigatorsofthestudyrequestthatyouusetheofficialversionofthemodifiedscorehere.TIMIRiskScoreforUA/NSTEMIEstimatesmortalityforpatientswithunstableanginaandnon-STelevationMI.WhentoUsePearls/PitfallsWhyUseCanbeusedtohelpriskstratifypatientswithpresumedischemicchestpain.However,itwasoriginallyderivedinpatientswithconfirmedunstableanginaornon-STelevationmyocardialinfarction.Oneoftheearliestchestpaindecisionrulesthatwaswidelyimplemented.OriginallyderivedwithpatientswithknownunstableanginaorNSTEMI.NewerchestpainriskscoressuchastheHEARTScorehavebeenshownto betterstratifyriskthantheTIMIScore,particularlyintheundifferentiatedchestpainpatient.ATIMIriskscoreof0or1doesnotequalzeroriskofadverseoutcome.Theoriginalstudyshowed4.7%ofpatientswithascoreof0or1hadadverseoutcomeswithin14days. Validationstudiesshowed1.7to2.1%ofpatientswithascoreof0stillhadadverseoutcomeswithin30days.Unclearifthisriskscorecanbeusedinpatientswithchestpaininthesettingofcocaineuse.TheTIMIScorewasfurtherstudiedaspartofanaccelerateddiagnosticprotocolintheADAPTtrial,whichincludesestimationofpre-testprobabilityusingTIMI,plusabnormalEKGandtroponin(high-sensitivitycardiactroponinI).UA/NSTEMIcansometimes bemissed.Traditionally,theTIMIRiskScoreforUA/NSTEMIcancorrelatetheriskofadverseoutcomeinchestpainpatients.Age≥65No0Yes+1≥3CADriskfactorsHypertension,hypercholesterolemia,diabetes,familyhistoryofCAD,orcurrentsmokerNo0Yes+1KnownCAD(stenosis≥50%)No0Yes+1ASAuseinpast7daysNo0Yes+1Severeangina(≥2episodesin24hrs)No0Yes+1EKGSTchanges≥0.5mmNo0Yes+1PositivecardiacmarkerNo0Yes+1Result:Pleasefilloutrequiredfields.NextStepsEvidenceCreatorInsightsDr.ElliottM.AntmanAbouttheCreatorElliottM.Antman,MD,isaprofessorandassociatedeanforClinical/TranslationalResearchatHarvardMedicalSchool.HeisalsoaseniorphysicianintheCardiovascularDivisionoftheBrighamandWomen'sHospitalinMassachusettsandPresidentoftheAmericanHeartAssociation(2014-2015).AsaseniorinvestigatorintheTIMIStudyGroup,Dr.Antmanhaspublishedontheuseofserumcardiacmarkersfordiagnosisandprognosisofpatientswithunstableanginaandacutemyocardialinfarction,cyclooxygenaseandcardiovascularrisk,andantithrombotictherapyforacutecoronarysyndromes.ToviewDr.ElliottM.Antman'spublications,visitPubMedAreyouDr.ElliottM.Antman?Sendusamessagetoreviewyourphotoandbio,andfindouthowtosubmitCreatorInsights!MDCalclovescalculatorcreators–researcherswho,throughintelligentandoftencomplexmethods,discovertoolsthatdescribescientificfactsthatcanthenbeappliedinpractice.Thesearerealscientificdiscoveriesaboutthenatureofthehumanbody,whichcanbeinvaluabletophysicianstakingcareofpatients.ContentContributorsHyunjooLee,MDCarlosRodriguez,MDRelatedCalcsTIMIRiskIndexFraminghamRiskScore(HardCoronaryHeartDisease)T-MACSHavefeedbackaboutthiscalculator?AbouttheCreatorDr.ElliottM.AntmanAreyouDr.ElliottM.Antman?AlsofromMDCalc...RelatedCalcsTIMIRiskIndexFraminghamRiskScore(HardCoronaryHeartDisease)T-MACSYoumightbeinterestedin...PartnerContentCalculatedDecisions:TIMIRiskScore(UA/NSTEMI)EmergencyMedicinePracticeContentContributorsHyunjooLee,MDCarlosRodriguez,MD