TIMI Risk Score for STEMI

TIMI Risk Score for STEMI estimates mortality in patients with STEMI Myocardial Infarction online calculator

TIMI Risk Score for STEMI estimates mortality in patients with STEMI Myocardial Infarction.

Age, years:
<65
65-74
≥75

Diabetes, Hypertension or Angina:
No
Yes

Systolic BP < 100 mmHg:
No
Yes

Heart rate > 100:
No
Yes

Killip Class II-IV
JVD or any pulmonary exam findings of CHF:

No
Yes

Weight < 67kg (147.7 lbs):
No
Yes

Anterior ST Elevation or LBBB:
No
Yes

Time to treatment > 4 hours:
No
Yes



Patient’s score Risk of all-cause mortality at 30 days
0 0

Addition of the assigned points.

CriteriaValue
Age < 65 years0
Age 65-74+2
Age ≥ 75+3
DM or Hypertension or Angina+1
Systolic BP < 100 mmHg+3
Heart Rate > 100+2
Killip Class II-IV+2
Weight < 67kg (147.7 lbs)+1
Anterior ST Elevation or LBBB+1
Time to Treatment > 4 hours+1

Interpretation of the results:

ScoreRisk of all-cause mortality at 30 days
0 points0.8%
1 points1.6%
2 points2.2%
3 points4.4%
4 points7.3%
5 points12.4%
6 points16.1%
7 points23.4%
8 points26.8%
9-14 points35.9%

The patient’s with an ST-Elevation Myocardial Infarction (STEMI) are already at high risk for complications and adverse outcomes, including death. This score was developed based on outcomes analyses in patient’s after thrombolytic therapy, which likely have worse outcomes when compared to PCI. The TIMI Score for STEMI was developed from the InTIME II trial of 15,000 STEMI patients and was studying these patients for thrombolytics.

The primary endpoint was 30-day all-cause mortality and did not include a placebo arm.

TIMI Risk Score for STEMI should be used in patients with diagnosed STEMI, not to evaluate patients with chest pain.

STEMI patients should receive guidelines recommended treatment, obviously undergo PCI or thrombolysis, depending on availability and standard of care at one’s hospital; risk stratification can be performed only after this most critical first step.

Literature:
David A. Morrow, et. al. 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; 102: 2031-2037 doi: 10.1161/01.CIR.102.17.2031 https://pubmed.ncbi.nlm.nih.gov/11044416/
Morrow DA, Antman EM, Parsons L, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA. 2001;286(11):1356-9. https://pubmed.ncbi.nlm.nih.gov/11560541/
Bradshaw PJ, Ko DT, Newman AM, Donovan LR, Tu JV. Validation of the Thrombolysis In Myocardial Infarction (TIMI) risk index for predicting early mortality in a population-based cohort of STEMI and non-STEMI patients. Can J Cardiol. 2007;23(1):51-6. https://pubmed.ncbi.nlm.nih.gov/17245483/
Silveira DS, Jaeger CP et al. Validation of TIMI risk score for STEMI. International Journal of Cardiovascular Sciences. 2016;29(3):189-197. http://www.onlineijcs.org/sumario/29/pdf/en_v29n3a06.pdf

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Assessment the degree of ST segment elevation on the ECG, J-point

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History of definite or probable MI (EKG changes and/or enzyme changes)

Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agents

Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)

History of a cerebrovascular accident with minor or no residua and transient ischemic attacks

Chronic cognitive deficit

Any history of treatment for ulcer disease or history of ulcer bleeding

Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history, mild = chronic hepatitis (or cirrhosis without portal hypertension)

Severe = on dialysis, status post kidney transplant, uremia, moderate = creatinine >3 mg/dL (0.27 mmol/L)


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