TIMI Risk Score Calculator — NSTEMI & Unstable Angina 14-Day Mortality & MACE Risk
Calculate the TIMI risk score for patients with non-ST-elevation acute coronary syndromes (NSTEMI/UA) to predict 14-day ischemic event risk and guide invasive strategy.
TIMI Risk Score Calculator
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This calculator is for informational and educational purposes. Results should be interpreted with clinical judgment and local guidelines.
What is the TIMI Risk Score for NSTEMI/UA?
The TIMI (Thrombolysis In Myocardial Infarction) Risk Score for Non-ST-Elevation Acute Coronary Syndromes (NSTEMI/UA) is a validated 7-point clinical prediction tool created by Antman et al. in 2000 from the TIMI 11B and ESSENCE clinical trial cohorts. It evaluates 7 independent predictor variables present at presentation: Age ≥ 65, ≥ 3 CAD risk factors, Known CAD (stenosis ≥ 50%), Aspirin use in last 7 days, Severe angina (≥ 2 episodes in 24h), ST-segment deviation ≥ 0.5mm, and Elevated cardiac biomarkers (Troponin or CK-MB). Each item scores 1 point for a total range of 0 to 7. The TIMI score predicts 14-day all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization, guiding early invasive coronary angiography vs ischemia-guided conservative management under ACC/AHA guidelines.
TIMI Score = Age ≥ 65 (+1) + ≥ 3 CAD risk factors (+1) + Known CAD ≥ 50% (+1) + Aspirin use last 7d (+1) + Severe angina ≤ 24h (+1) + ST deviation ≥ 0.5mm (+1) + Positive troponin (+1). Score 0–2: Low risk (4.7–8.3%); 3–4: Intermediate (13.2–19.9%); 5–7: High risk (26.2–40.9%).
When to Use the TIMI Risk Score
- Emergency department triage and risk stratification of patients presenting with chest pain and confirmed or suspected NSTEMI / Unstable Angina.
- Selecting therapeutic strategy: ACC/AHA guidelines recommend an early invasive strategy (coronary angiography within 24h) for high-risk patients (TIMI ≥ 3 or GRACE > 140).
- Guiding glycoprotein IIb/IIIa inhibitor or potent P2Y12 inhibitor (Ticagrelor/Prasugrel) selection in high-risk ACS patients.
TIMI Risk Score Criteria Breakdown (1 Point Each)
TIMI Total Score Formula
TIMI Score = Sum of 7 positive criteria (0–7 points)
Age 68 (+1) + HTN/DM/Smoking (+1) + ST depression 1mm (+1) + Elevated Troponin (+1) = Total TIMI Score 4 (Intermediate Risk)
Variables
Age ≥ 65 years (+1 point)
Patient age 65 years or older.
≥ 3 CAD Risk Factors (+1 point)
Hypertension, hypercholesterolemia, diabetes, smoking, or family history of premature CAD.
Known CAD (Stenosis ≥ 50%) (+1 point)
Prior catheterization showing ≥ 50% coronary stenosis or prior MI/CABG/PCI.
Aspirin use in past 7 days (+1 point)
Use of aspirin prior to presentation (indicates treatment failure / resistant disease).
Severe Angina (≥ 2 episodes in 24h) (+1 point)
Recurrent ischemic chest pain at rest or minimal exertion within 24 hours.
ST Deviation ≥ 0.5 mm (+1 point)
ST depression or transient ST elevation ≥ 0.5 mm on presentation ECG.
Elevated Cardiac Biomarkers (+1 point)
Positive cardiac Troponin I/T or CK-MB above local lab upper limit of normal.
Max score = 7; Min score = 0.
TIMI Score 14-Day Risk & Strategy Table
Predicts 14-day composite endpoint: All-cause mortality, new/recurrent MI, or urgent revascularization.
| Range | Classification | Health Risk |
|---|---|---|
| 0–1 points | Low Risk | 4.7–4.9% 14-day MACE. Ischemia-guided conservative management option. |
| 2 points | Low Risk | 8.3% 14-day MACE. Outpatient or conservative workup if biomarker negative. |
| 3 points | Intermediate Risk | 13.2% 14-day MACE. Early invasive strategy (angiography within 24h) recommended. |
| 4 points | Intermediate Risk | 19.9% 14-day MACE. Early invasive strategy + dual antiplatelet therapy. |
| 5 points | High Risk | 26.2% 14-day MACE. Urgent invasive angiography; intensive anti-ischemic care. |
| 6–7 points | Very High Risk | 30.9–40.9% 14-day MACE. Immediate/urgent cardiac catheterization lab transfer. |
GRACE score provides superior 6-month mortality discrimination, but TIMI is faster at bedside.
Limitations & Clinical Warnings
Validated ONLY for NSTEMI / Unstable Angina. Do NOT use for STEMI (use TIMI for STEMI score instead).
A low TIMI score (0–1) does NOT rule out ACS; high-sensitivity troponin and clinical judgment remain essential.
Does not include hemodynamic instability (hypotension, heart failure) which independently mandates emergency cardiac cath.
Medical Disclaimer
TIMI score is a risk stratification tool. Any patient with refractory chest pain or hemodynamic instability requires emergency intervention regardless of score.
References & Citations
- 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. PMID: 10938172 | DOI: 10.1001/jama.284.7.835
Medically Reviewed
Reviewed by CliniqWise Clinical Advisory Board — Interventional Cardiology Panel · Last updated: 2026-08-27 · Next review: 2027-02-27
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