π TIMI Risk Score for UA/NSTEMI
Seven yes-or-no questions that triage chest pain.
TIMI UA/NSTEMI score (0-7)
For informational purposes only, not medical advice.
The TIMI score for unstable angina and NSTEMI counts seven yes-or-no risk factors, one point each. A patient who is 65 or older, has three cardiac risk factors, used aspirin this week, and had two angina episodes in 24 hours scores 4 of 7, with a 19.9% thirty-day rate of death, heart attack, or urgent revascularization. Published by Antman and colleagues in 2000, it turned gestalt into arithmetic for the most common cardiac admission.
Unlike its STEMI sibling, every variable here weighs the same. The democracy is deliberate: in non-ST-elevation syndromes, no single bedside fact dominates, so the count itself becomes the signal.
How to Use This Calculator
Answer the seven questions from the history, ECG, and labs. Each yes adds one point; the total maps to the published event rate.
Answer the history items: age 65+, three or more CAD risk factors (family history, hypertension, high cholesterol, diabetes, smoking), known coronary stenosis of 50% or more, and aspirin use in the last 7 days.
Answer the presentation items: two or more angina episodes in 24 hours, ST-segment deviation of 0.5 mm or more, and a positive cardiac marker.
Read the score and the 30-day event rate. Higher scores push toward early invasive management.
The Seven Variables and Event Rates
| Score | 30-day death/MI/urgent revascularization |
|---|---|
| 0 to 1 | 4.7% |
| 2 | 8.3% |
| 3 | 13.2% |
| 4 | 19.9% |
| 5 | 26.2% |
| 6 to 7 | 40.9% |
The aspirin item surprises people: needing aspirin recently marks refractory disease, not protection. Similarly, the angina and marker items capture active instability. The score essentially counts how many ways the presentation says this plaque is angry.
Worked Example
A 68-year-old with hypertension, diabetes, and smoking history takes daily aspirin, and reports three episodes of rest chest pain in the last day. Troponin is pending and the ECG shows no ST deviation. Score: age 1, risk factors 1, aspirin 1, angina episodes 1, known CAD 0, ST deviation 0, marker 0, totaling 4.
At 4 points the event rate is 19.9%, firmly in the zone where guidelines favor an early invasive strategy with angiography. The pending troponin can only raise the score, never lower it, which is itself useful information for planning.
Reading Your Result
Scores of 0 to 2 generally support selective or conservative management with stress testing; 3 to 4 push toward early angiography; 5 and above mark high risk where invasive management is strongly favored. But the score never overrides instability: ongoing pain, hemodynamic compromise, or dangerous arrhythmias go to the cath lab on clinical grounds at any score.
My take: the score's greatest value is in the middle. A 3 or 4 turns a vague admission into a timed plan, which is where most NSTEMI care actually lives.
Limits
The score predates high-sensitivity troponins, which reclassify many patients, and modern antiplatelet regimens have shifted absolute event rates down. It also ignores renal function, bleeding risk, and frailty, all of which shape real decisions. Use it as the starting framework, not the final word.
Related Tools
For the STEMI version see our TIMI STEMI calculator. Two inputs have dedicated checkers: the blood pressure checker and the diabetes risk calculator.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the TIMI risk score for UA/NSTEMI?
A 7-point score predicting 30-day death, MI, or urgent revascularization in unstable angina and non-ST-elevation MI. Each of seven factors, age, risk factors, known CAD, recent aspirin, recurrent angina, ST deviation, positive marker, scores one point. Published by Antman et al. in JAMA, 2000.
How do you calculate the TIMI NSTEMI score?
Count yes answers across the seven items, one point each, for a total of 0 to 7. Then read the event rate: 0-1 = 4.7%, 2 = 8.3%, 3 = 13.2%, 4 = 19.9%, 5 = 26.2%, 6-7 = 40.9%.
Why does recent aspirin use add a point?
Because it marks refractory disease: angina breaking through aspirin suggests an active, unstable plaque rather than a first event. It is a marker of severity, not a penalty for treatment.
What score needs a cardiac cath?
Guidelines generally favor early invasive management at scores of 3 and above, more strongly at 5+. But unstable patients go regardless of score, and low scores with high bleeding risk may stay conservative.
What is the difference between the two TIMI scores?
The STEMI score uses 8 weighted variables and predicts 30-day mortality; the UA/NSTEMI score uses 7 unweighted variables and predicts a composite of death, MI, and urgent revascularization. They apply to different presentations and do not interchange.
Do high-sensitivity troponins change the score?
They change who counts as marker-positive, pulling more patients into higher scores. The score's structure still works, but absolute event rates in modern cohorts run lower than the original table.
What counts as a CAD risk factor here?
Family history of CAD, hypertension, hypercholesterolemia, diabetes, and current smoking. Three or more earns the point. Age 65+ is its own separate item.
Can the score rule out MI?
No. Even a score of 0 carries about a 5% event rate, which is why serial troponins and clinical judgment remain mandatory. The score stratifies; it does not exclude.
How does this compare to GRACE?
GRACE uses continuous variables and predicts mortality more precisely but needs a calculator; TIMI is simpler bedside arithmetic. Many clinicians use both, TIMI for speed and GRACE for precision.
Who should use this calculator?
Clinicians, students, and anyone learning cardiac risk stratification. It reproduces a published score for education. Chest pain is an emergency; this page never replaces urgent medical evaluation.