TIMI Risk Score for UA/NSTEMI
7-point score predicting 14-day risk of all-cause mortality, new or recurrent MI, or severe recurrent ischaemia requiring revascularisation in UA/NSTEMI.
How to use & interpret
The TIMI risk score for unstable angina/NSTEMI estimates 14-day risk of death, new/recurrent MI, or severe recurrent ischaemia needing revascularisation, from seven equally-weighted variables (age ≥65, ≥3 coronary risk factors, known CAD ≥50% stenosis, aspirin in the last 7 days, ≥2 anginal episodes in 24h, ST deviation, and a positive biomarker).
It is quick at the bedside and helps flag patients who benefit from a more aggressive (early invasive) strategy. It is less granular than GRACE, which most UK guidelines prefer for formal risk stratification.
Score interpretation
TIMI UA/NSTEMI 0–2: Low risk. 14-day MACE rate ~5%.
→ Aspirin 300mg loading. Serial troponins. Consider conservative management. Stress testing before discharge. Outpatient cardiology follow-up.
TIMI UA/NSTEMI 3–4: Intermediate risk. 14-day MACE rate ~13%.
→ Aspirin + ticagrelor (or clopidogrel). LMWH/fondaparinux. Serial ECG and troponins. Consider early invasive strategy (angiography within 24–72h). Cardiology review.
TIMI UA/NSTEMI 5–7: High risk. 14-day MACE rate ~26–41%. Early invasive strategy strongly indicated.
→ Dual antiplatelet + anticoagulation. Urgent cardiology review. Angiography within 24h (ideally < 2h if haemodynamically unstable or ECG changes). GPIIb/IIIa inhibitor if PCI planned. ICU/HDU monitoring.
Interpretation bands for the TIMI UA/NSTEMI. Apply clinical judgement and local guidance.
Frequently asked questions
TIMI or GRACE for NSTEMI?
GRACE discriminates risk better and is preferred by ESC/NICE for deciding invasive timing; TIMI is simpler and useful for rapid bedside estimation. Many units calculate both.
References
- Antman EM et al. The TIMI risk score for unstable angina/non-ST elevation MI. JAMA. 2000.
- ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Isosorbide Mononitrate (Stable Angina) · Nitrate / Stable Angina
- Nicorandil · Stable Angina
- Ranolazine · Refractory Stable Angina
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Indocyanine Green (Intravitreal Chromovitrectomy) · Diagnostic Dye — Vitreoretinal Surgery / ICG Angiography
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The TIMI UA/NSTEMI is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.