What Is a TIMI Risk Score?

Medically Reviewed by James Beckerman, MD, FACC on February 14, 2024
4 min read

A TIMI risk score is based on a number of factors and is used to estimate how likely it is that someone might have serious or life-threatening heart consequences. The score measures risks for people who have certain types of chest pain or heart attacks. TIMI risk scores are used to guide treatment and find the best options for your heart condition.

Only people who are considered at high or medium risk are given a TIMI classification. The main risk factors that prompt calculating a TIMI score are:

  • Unstable angina (UA). Also called acute coronary syndrome, the most common symptom of this condition is chest pain that occurs unexpectedly while you are at rest. It is usually caused by fatty buildup in the arteries providing blood flow to your heart (your coronary arteries). The fatty buildup can burst and cause blood clotting that blocks blood flow to the heart. Unstable angina should be treated with caution. It can easily lead to heart attacks, arrhythmia (irregular heartbeat), or cardiac arrest (when the heart stops beating and needs to be restarted). 
  • Non-ST-Elevation myocardial infarction (NSTEMI). This is a type of heart attack in which one of the coronary arteries is blocked, and the blood flow of oxygen-rich blood is reduced. Symptoms of NSTEMI are chest pain, dizziness, nausea, shortness of breath, and sweating. It can be caused by diabetes, coronary artery disease, high cholesterol, hypertension, and smoking. Blood testing and an electrocardiogram can determine if you have had an NSTEMI event.

Some of the criteria used to score the TIMI are:

  • Being over age 65
  • Having at least three risk factors for coronary artery disease, such as diabetes, hypertension, smoking, or a family history of heart disease
  • Taking aspirin in the past week
  • Severe unstable angina in the past twenty-four hours
  • Dramatic changes on your electrocardiogram scans 
  • Specific markers in your cardiac health

Each one of these categories represents one point on the TIMI scale. The higher the TIMI score, the more likely you are to be at risk for heart problems and death. The TIMI score can range between one and seven. Scores from zero to two are low risk, three to five are intermediate risk, and scores six to seven are high risk.

Each of the points on the scale can be understood as follows:

  • If you get one point, you are at 5% risk for heart-related mortality.
  • Two points on the scale means you are at 8% risk for mortality.
  • Three points on the TIMI scale means that you are at 13% at risk for mortality.
  • If you get four points on the scale, you are at 20% risk. 
  • Five points on the TIMI scale means that you are at a 26% risk level.
  • Scoring six points on the scale means that you are at 41% risk. 
  • Seven points also means that you are at 41% risk. 

TIMI risk scores have been found to effectively measure the functioning of the coronary blood vessels that provide blood flow to the heart. However, one flaw in the TIMI scale is that some categories included in the score have been found to carry more medical weight than others. TIMI scoring does not reflect this weighting.

The most common symptom of UA/NSTEMI is chest pain.  Chest pain is also one of the most common reasons you may visit the hospital. A high TIMI score should not be understated, but it is possible to lower the score.

The four main ways that people treat their heart health if they have a TIMI score are:

  • Anti-ischemic therapy. This is simply taking various medications such as beta-blockers, calcium blockers, nitrates, and other medicines that help your arteries pump your blood. Often you may need to take these medications intravenously. 
  • Antiplatelet/anticoagulant therapy. This therapy is aimed at helping the sticky blood cells in your blood (platelets) not stick together and form blood clots. Aspirin is the most common medicine to take as antiplatelet therapy. However, there are several other medications that your doctor can prescribe.
  • Invasive therapy. You may need to have a procedure done to increase your body’s ability to move blood through your heart, such as cardiac catheterization or revascularization. Both of these procedures are done through surgery and aim at either aiding your arteries or pumping blood at an increased rate. 
  • Lifestyle management and prevention. A great way to look at TIMI score interpretation is that you have received a piece of news that can save your life. For example, if you have unmanaged diabetes, are overweight, do not exercise, use tobacco products, and have a diet that is not optimal for heart health, getting a TIMI score is your sign to make some significant lifestyle changes. Taking these simple yet often difficult steps can completely change your life.