TIMI Risk Score Calculator — UA/NSTEMI 14-Day Risk

TIMI Score	14-Day Risk of Death/MI/Urgent Revasc.
0-1	4.7%
2	8.3%
3	13.2%
4	19.9%
5	26.2%
6-7	40.9%

Criterion	Definition
Age ≥ 65	Patient is 65 years of age or older at presentation.
≥ 3 CAD risk factors	3 or more of: family history of CAD, hypertension, hypercholesterolemia, diabetes mellitus, current smoking.
Known CAD	Prior documented coronary artery stenosis of 50% or greater on angiography.
Aspirin use, prior 7 days	Aspirin taken by the patient at any point in the 7 days before presentation.
Severe angina	2 or more anginal episodes in the preceding 24 hours.
ST deviation ≥ 0.5mm	ST-segment elevation or depression of 0.5mm or more on the presenting EKG.
Elevated cardiac biomarkers	Initial troponin or CK-MB above the local laboratory's upper reference limit.

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Walk-through

How to Use This Calculator

7 steps

1

Confirm age ≥ 65

Check the box if the patient is 65 years of age or older at presentation. Age ≥ 65 is worth 1 point.

2

Count ≥ 3 CAD risk factors

Tally family history of coronary artery disease, hypertension, high cholesterol, diabetes, and current smoking. Check the box if 3 or more of these are present.

3

Confirm known CAD

Check the box if the patient has a prior documented coronary artery stenosis of 50% or greater on angiography.

4

Confirm aspirin use in the prior 7 days

Check the box if the patient reports taking aspirin at any point in the 7 days before presentation.

5

Confirm severe angina

Check the box if the patient has had 2 or more anginal episodes in the preceding 24 hours.

6

Confirm ST deviation

Check the presenting EKG for ST-segment deviation of 0.5mm or more. Check the box if present.

7

Confirm elevated cardiac biomarkers

Check the box if the initial troponin or CK-MB is above the local laboratory's upper reference limit.

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Reference

Formula & Methodology

1 formula

TIMI Risk Score (UA/NSTEMI)

TIMI Score = sum of 7 criteria (1 point each), range 0-7

Each of the 7 criteria (age ≥65, ≥3 CAD risk factors, known CAD, aspirin use in the prior 7 days, severe angina, ST deviation ≥0.5mm, and elevated cardiac biomarkers) contributes 1 point if present, for a total score of 0 to 7. The total maps to a published 14-day risk of death, myocardial infarction, or urgent revascularization: 0-1 → 4.7%, 2 → 8.3%, 3 → 13.2%, 4 → 19.9%, 5 → 26.2%, 6-7 → 40.9%. The score and its associated risk percentages come from Antman EM et al., JAMA 2000.

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High YMYL

Trust, Methodology & Sources

Reviewed by Calculover Clinical Content Team · Updated 2026-07-22 · 2 sources

Editorial accountability

Author: Calculover Clinical Content Team - Clinical calculator content authoring

Owner: Calculover Editorial Team - Health & Fitness category editorial owner

Reviewer: Calculover Clinical Content Team - Clinical reviewer

Last reviewed: 2026-07-22

Last verified: 2026-07-22

Data effective: 2026-07-22

Methodology

The TIMI risk score for UA/NSTEMI sums 7 binary clinical/laboratory criteria (age ≥65, ≥3 CAD risk factors, known CAD, aspirin use in the prior 7 days, severe angina, ST deviation ≥0.5mm, elevated cardiac biomarkers), each worth 1 point, for a total of 0-7. The associated 14-day risk of death, MI, or urgent revascularization (4.7% to 40.9%) is taken directly from the original derivation and validation study (Antman EM, Cohen M, Bernink PJ, et al. JAMA. 2000;284(7):835-42).

Assumption: The patient presents with unstable angina or non-ST-elevation myocardial infarction (UA/NSTEMI), not STEMI.

Assumption: The 'elevated cardiac biomarkers' criterion reflects an initial troponin or CK-MB value above the local laboratory's own upper reference limit.

Assumption: The '≥3 CAD risk factors' criterion counts family history of CAD, hypertension, hypercholesterolemia, diabetes mellitus, and current smoking.

Limitations & guidance

Not validated for ST-elevation myocardial infarction (STEMI) — that population uses a separate TIMI risk score.

Not intended for hemodynamically unstable patients, who require immediate acute coronary syndrome protocol activation regardless of the calculated score.

This calculator is a decision-support aid, not a diagnostic tool, and does not replace the judgment of a treating clinician or an institution's own ACS protocol.

Professional guidance: This calculator is for clinical decision support and educational purposes only. It is not a substitute for professional medical judgment, diagnosis, or treatment, and it does not replace an institution's own acute coronary syndrome protocol. Always use clinical judgment and consult appropriate specialists when managing a patient with UA/NSTEMI.

Primary sources

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):835-42.

MDCalc — TIMI Risk Score for UA/NSTEMI

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Glossary

Key Terms Explained

7 terms

TIMI score A 7-item, 0-7 point clinical decision tool for patients with unstable angina or NSTEMI that estimates the 14-day risk of death, myocardial infarction, or urgent revascularization.

UA/NSTEMI Unstable angina and non-ST-elevation myocardial infarction — two closely related acute coronary syndromes that present without the ST-segment elevation seen in STEMI, but that share overlapping risk and treatment pathways.

Revascularization A procedure — typically percutaneous coronary intervention (angioplasty/stenting) or coronary artery bypass grafting — that restores blood flow through a narrowed or blocked coronary artery.

CAD risk factors For this score: family history of coronary artery disease, hypertension, hypercholesterolemia, diabetes mellitus, and current smoking. Three or more of these present scores 1 point.

Cardiac markers Biomarker proteins such as troponin or CK-MB released into the blood when heart muscle is damaged. An initial value above the local assay's normal limit counts as 'elevated' for this score.

ST deviation Displacement of the ST segment on an EKG — either elevation or depression — of 0.5mm or more, indicating possible myocardial ischemia.

Aspirin use (prior 7 days) Aspirin taken by the patient at any point in the 7 days before presentation. Having an event despite recent aspirin use is a marker of higher risk in the original derivation.

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Scenarios

Real-World Examples

3 worked examples

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Lower-risk presentation

A 58-year-old with known CAD and a positive troponin, but no other criteria present.

Age ≥ 65 No ≥ 3 CAD risk factors No Known CAD Yes Aspirin use (prior 7 days) No Severe angina No ST deviation ≥ 0.5mm No Elevated cardiac biomarkers Yes

Total score 2 — 8.3% 14-day risk of death, MI, or urgent revascularization. This lower-intermediate range is often managed with a more conservative, ischemia-guided approach depending on clinical context.

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Intermediate-to-high-risk presentation

A 70-year-old on aspirin with known CAD, severe angina, and a positive troponin.

Age ≥ 65 Yes ≥ 3 CAD risk factors No Known CAD Yes Aspirin use (prior 7 days) Yes Severe angina Yes ST deviation ≥ 0.5mm No Elevated cardiac biomarkers Yes

Total score 5 — 26.2% 14-day risk of death, MI, or urgent revascularization. Scores in this range commonly prompt consideration of an early invasive strategy per guideline-based care.

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Highest-risk presentation

A 71-year-old with all 7 TIMI criteria present at admission.

Age ≥ 65 Yes ≥ 3 CAD risk factors Yes Known CAD Yes Aspirin use (prior 7 days) Yes Severe angina Yes ST deviation ≥ 0.5mm Yes Elevated cardiac biomarkers Yes

Total score 7 — 40.9% 14-day risk of death, MI, or urgent revascularization. This is the highest published risk band, roughly nine times the risk at a score of 0-1, and warrants urgent cardiology involvement.

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Deep Dive

Understanding the TIMI Risk Score for UA/NSTEMI

3 chapters · 4 min read

The TIMI risk score is a widely used bedside tool for stratifying patients with unstable angina or non-ST-elevation myocardial infarction (UA/NSTEMI). It converts 7 pieces of clinical information already gathered at presentation into a single 0-7 number that estimates a patient's 14-day risk of death, MI, or urgent revascularization, helping guide how aggressively to manage the case.

How the TIMI risk score works

Each of the 7 criteria — age 65 or older, 3 or more CAD risk factors, known coronary artery disease, aspirin use in the prior 7 days, severe angina, ST-segment deviation of 0.5mm or more, and elevated cardiac biomarkers — is scored as present (1 point) or absent (0 points), for a total of 0 to 7. The total maps to a published 14-day risk of death, myocardial infarction, or urgent revascularization, ranging from 4.7% at a score of 0-1 up to 40.9% at a score of 6-7. These risk percentages come from the original derivation and validation cohorts reported by Antman et al. (JAMA 2000).

The 7 criteria

Some criteria reflect baseline cardiovascular risk (age, risk factor count, known CAD), while others reflect the acuity of the current presentation (severe angina, ST deviation, elevated biomarkers). The aspirin criterion is somewhat distinct: an event occurring despite recent aspirin use suggests a more treatment-resistant process and was independently associated with worse outcomes in the derivation cohort. Because each criterion contributes equally (1 point), the score is quick to calculate at the bedside without weighting calculations.

Scope and limitations

The TIMI risk score for UA/NSTEMI was derived and validated in patients with unstable angina or non-ST-elevation MI — it is not intended for ST-elevation MI (STEMI), which has its own separate TIMI risk score, or for hemodynamically unstable patients who need immediate protocol activation regardless of score. Like most clinical risk scores, it estimates population-level risk and does not replace an individualized clinical assessment, additional risk-stratification tools, or a treating clinician's judgment about revascularization timing.

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Questions

Frequently Asked Questions

6 questions

What does TIMI stand for?+

TIMI stands for Thrombolysis In Myocardial Infarction — the name of the clinical trial group whose risk model this score comes from. The TIMI risk score for UA/NSTEMI was derived using data from the TIMI 11B trial and validated in the ESSENCE trial (Antman et al., JAMA 2000).

What is the TIMI score range?+

The TIMI risk score for UA/NSTEMI ranges from 0 to 7, with 1 point awarded for each of 7 clinical and laboratory criteria present at the time of presentation.

What is the highest-risk score band?+

Scores of 6 or 7 form the highest-risk band, corresponding to a published 14-day risk of death, myocardial infarction, or urgent revascularization of about 40.9% — roughly nine times the risk at a score of 0-1 (4.7%).

How is the TIMI score used clinically?+

The score helps clinicians gauge how aggressively to manage a patient with unstable angina or NSTEMI. Higher scores, typically 3 and above, are often used to support a decision toward an early invasive strategy (prompt angiography and revascularization) and more intensive antithrombotic therapy, though the final decision always rests on the treating clinician's overall assessment.

What population was the TIMI risk score validated in?+

The score was derived from patients enrolled in the TIMI 11B trial and validated in the ESSENCE trial, both of which enrolled patients with unstable angina or non-ST-elevation myocardial infarction. It has not been validated for ST-elevation MI (STEMI), which uses a separate, distinct TIMI risk score.

Why does the aspirin criterion specifically require use in the prior 7 days?+

Aspirin use in the 7 days before presentation identifies patients who developed an acute coronary event despite already being on antiplatelet therapy — a marker the original derivation study found predicted a higher risk of subsequent events, independent of the other 6 criteria.

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TIMI Risk Score Calculator (UA/NSTEMI)

TIMI Criteria (1 point each)

Score & 14-Day Risk

14-Day Risk by TIMI Score

TIMI Criteria — Full Definitions

How to Use This Calculator

Confirm age ≥ 65

Count ≥ 3 CAD risk factors

Confirm known CAD

Confirm aspirin use in the prior 7 days

Confirm severe angina

Confirm ST deviation

Confirm elevated cardiac biomarkers

Formula & Methodology

Trust, Methodology & Sources

Key Terms Explained

Real-World Examples

Lower-risk presentation

Intermediate-to-high-risk presentation

Highest-risk presentation

Understanding the TIMI Risk Score for UA/NSTEMI

How the TIMI risk score works

The 7 criteria

Scope and limitations

Frequently Asked Questions

Get a branded PDF of your results

TIMI Risk Score Calculator (UA/NSTEMI)

TIMI Criteria (1 point each)

Score & 14-Day Risk

14-Day Risk by TIMI Score

TIMI Criteria — Full Definitions

How to Use This Calculator

Confirm age ≥ 65

Count ≥ 3 CAD risk factors

Confirm known CAD

Confirm aspirin use in the prior 7 days

Confirm severe angina

Confirm ST deviation

Confirm elevated cardiac biomarkers

Formula & Methodology

Trust, Methodology & Sources

Key Terms Explained

Real-World Examples

Understanding the TIMI Risk Score for UA/NSTEMI

How the TIMI risk score works

The 7 criteria

Scope and limitations

Frequently Asked Questions

Get a branded PDF of your results

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