Makindo Medical Notes

🫀 The TIMI (Thrombolysis In Myocardial Infarction) score is a bedside tool used to stratify risk in patients with suspected acute coronary syndrome (ACS). ⚡ By combining simple clinical and ECG findings, it helps predict the likelihood of adverse events (MI, urgent revascularisation, or death). 🎯 Its strength lies in guiding decisions about early angiography, PCI, or surgery versus conservative management.

📌 About

• 🧾 TIMI identifies high- and intermediate-risk patients who benefit from early invasive strategies (angiography/angioplasty).
• 👩‍⚕️ All patients with chest pain suspected to be cardiac should undergo TIMI scoring.
• ⚠️ Remember: TIMI stratifies risk within cardiac chest pain — it does not distinguish cardiac vs non-cardiac chest pain.

🧮 TIMI Score Components

📊 Risk Stratification

💡 Clinical Implications

• 🟢 Low Risk (0–2): Often managed conservatively; outpatient stress testing + medical therapy.
• 🟡 Intermediate Risk (3–4): Consider early invasive strategy (angiography ± PCI).
• 🔴 High Risk (5–7): Requires urgent invasive management (PCI or CABG if anatomy unsuitable).

🧑‍⚕️ Clinical Pearls

• 📈 Higher TIMI = higher mortality + MACE (major adverse cardiac events).
• 🔍 TIMI complements (not replaces) clinical judgement and biomarkers.
• ♻️ Reassess regularly — risk profile may evolve.
• 🧪 A TIMI >3 generally prompts early invasive work-up in UK/European practice (per ESC/NICE guidelines).

🛠️ Management Pathway by TIMI

• 🟢 Low Risk (0–2): Medical therapy (aspirin, statins, beta-blocker, nitrates), consider exercise test.
• 🟡 Intermediate (3–4): Coronary angiography within 24–72h, PCI if culprit lesion found.
• 🔴 High Risk (5–7): Urgent PCI (primary if STEMI; early invasive if NSTEMI/UA). CABG if multi-vessel/left main disease.

📚 References

• TIMI Study Group
• Original TIMI Risk Score Paper (NEJM)
• NICE Chest Pain/ACS Guideline
• ESC ACS Guidelines