The TIMI risk score is composed of seven independent predictor variables, each carrying a similar prognostic weight, shown in the table. What are the components of the TIMI risk score? Although it can be used for patients with anginal symptoms, it is better suited for patients with confirmed NSTEMI or UA. It estimates 30 day mortality for patients with UA and NSTEMI. One of the most widely used is the Thrombolysis in Myocardial Infarction (TIMI) risk score. Several risk stratification ‘scores’ are available and are based on clinical history, ECG findings and cardiac markers. Thrombolysis in Myocardial Infarction (TIMI) Ī formal risk assessment should include a full clinical history (including age, previous myocardial infarction and previous PCI or coronary artery bypass grafting ), a physical examination (including measurement of blood pressure and heart rate), a resting 12‑lead ECG, looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia, blood tests (such as troponin I or T, creatinine, glucose and haemoglobin). In order to select the most appropriate treatment, early and repeated risk stratification should be performed since the benefit from certain aggressive treatment strategies is related to risk – the higher the risk, the greater the benefit.Īs per NICE, as soon as the diagnosis of unstable angina or NSTEMI is made, and aspirin and antithrombin therapy have been offered, formally assess individual risk of future adverse cardiovascular events using an established risk scoring system that predicts 6‑month mortality (for example, Global Registry of Acute Cardiac Events ). Patients with ACS are a heterogeneous population with varying degrees of atherosclerotic disease and thrombotic risk and, therefore, varying mortality and recurrent cardiac event rates. Risk stratification and management of ACS is the subject of this session. Many patients without ST elevation may not have a subsequent cardiac marker rise and are collectively termed non-ST-segment elevation acute coronary syndromes (ACS) at presentation subsequently, their markers will define them as non-STEMI (marker rise) or UA (no marker rise). Most patients with ST elevation progress to STEMI their management is the subject of a separate Learning Session. At the time of presentation, however, cardiac marker status is unknown and classification of patients presenting with ischaemic chest pain is based largely on the ECG. In the context of cardiac marker rise, ST-segment changes on the ECG will define either STEMI or NSTEMI. ![]() Myocardial infarction (MI) is defined pathologically as myocardial cell death following prolonged ischaemia. The chart shows the classification of ACS. Understanding the pathophysiology, classification and clinical presentation of ACS is a pre-requisite for effective risk stratification and treatment. Acute Coronary Syndromes (ACS) encompass a broad range of presentations including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
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