TIMI Risk Score for STEMI

Why Use

Studies on clinician gestalt estimating mortality and complication risk often underestimate risk, and guidelines recommend higher risk patients receiving more aggressive medical interventions.

When to Use

A patient with an ST-Elevation Myocardial Infarction (STEMI) who is post-cath may have bleeding risks and the primary team would like to help objectify risk-benefit of post-PCI medications.

Formula

Pearls / Pitfalls

Obviously patients with STEMI are already at high risk for complications and adverse outcomes, including death. The TIMI Risk Score for STEMI may help a cardiology, medical and/or intensive care team with weighing risk/benefit of medications (like anticoagulation) and invasive procedures by knowing a patient’s baseline risk. This score was developed based on thrombolytic outcomes, which likely have worse outcomes when compared to PCI. Should be used in patients with diagnosed STEMI, NOT to evaluate patients with chest pain.

Management

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

More Information

Criteria Value Age < 65 years 0 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