TIMI

The 'Thrombolysis In Myocardial Infarction', or TIMI Study Group is an Academic Research Organization (ARO) affiliated with Brigham and Women's Hospital and Harvard Medical School. The group has its headquarters in Boston, Massachusetts, and a satellite location in Quincy.

The TIMI Study Group was founded by Eugene Braunwald, MD in 1984. Dr. Braunwald held the chairmanship until 2010, when he appointed Marc Sabatine, MD to the position. The group has conducted numerous practice-changing clinical trials in patients with cardiovascular disease or risk factors for cardiovascular disease. Among the group's most important contributions to medicine is the TIMI Risk Score, which assess the risk of death and ischemic events in patients experiencing unstable angina or a non-ST elevation myocardial infarction.

TIMI Calculators

TIMI Risk Score

In patients with UA/NSTEMI, the TIMI risk score is a simple prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making.^[1]

TIMI Score Calculation (1 point for each):

• Age ≥ 65
• Aspirin use in the last 7 days (patient experiences chest pain despite ASA use in past 7 days)
• At least 2 angina episodes within the last 24hrs
• ST changes of at least 0.5mm in contiguous leads
• Elevated serum cardiac biomarkers
• Known Coronary Artery Disease (CAD) (coronary stenosis ≥ 50%)
• At least 3 risk factors for CAD, such as:
  • Hypertension -> 140/90 or on anti-hypertensives
  • Current cigarette smoker
  • Low HDL cholesterol (< 40 mg/dL)
  • Diabetes mellitus
  • Family history of premature CAD
    • Male first-degree relative or father younger than 55
    • Female first-degree relative or mother younger than 65

Score Interpretation:

% risk at 14 days of: all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization.^[2]

• Score of 0-1 = 4.7% risk
• Score of 2 = 8.3% risk
• Score of 3 = 13.2% risk
• Score of 4 = 19.9% risk
• Score of 5 = 26.2% risk
• Score of 6-7 = at least 40.9% risk

'TIMI risk' estimates mortality following acute coronary syndromes. TIMI risk can be calculated on the TIMI website under "Clinical Calculators." ^[3]

The TIMI Risk Score for STEMI is also useful for patients with known STEMI. Though these patients have a clear protocol - normally thrombolysis or Percutaneous coronary intervention - and are already high risk for mortality, the TIMI Risk Score for STEMI provide risk stratification which helps treatment decisions after acute issues have been resolved.^[4]

TIMI Grade Flow

'TIMI Grade Flow' is a scoring system from 0-3 referring to levels of coronary blood flow assessed during percutaneous coronary angioplasty:

• TIMI 0 flow (no perfusion) refers to the absence of any antegrade flow beyond a coronary occlusion.
• TIMI 1 flow (penetration without perfusion) is faint antegrade coronary flow beyond the occlusion, with incomplete filling of the distal coronary bed.
• TIMI 2 flow (partial reperfusion) is delayed or sluggish antegrade flow with complete filling of the distal territory.
• TIMI 3 is normal flow which fills the distal coronary bed completely

TIMI score Mnemonic

AMERICA:
Age ≥ 65
Markers (increased serum cardiac markers)
ECG (ST depression)
Risk factors (3 or more CAD risk factors: patient age (>45 M, > 55 F), family history [CAD in first degree relatives, <55 M, <65 F), hypercholesterolemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle, metabolic syndrome)
Ischemia (2 or more anginal events over past 24 hours)
CAD (prior coronary stenosis of 50% or more)
Aspirin use within past 7 days
^[5]

References

1. Elliott M. Antman, MD; Marc Cohen, MD; Peter J. L. M. Bernink, MD; Carolyn H. McCabe, BS; Thomas Horacek,MD,"The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI", JAMA, 2000
2. Antman, Elliott M.; Cohen, Marc; Bernink, Peter J. L. M.; McCabe, Carolyn H.; Horacek, Thomas; Papuchis, Gary; Mautner, Branco; Corbalan, Ramon; Radley, David; Braunwald, Eugene (2000). "The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI". JAMA. 284 (7): 835. doi:10.1001/jama.284.7.835. ISSN 0098-7484.
3. TIMI Risk Score
4. David A. Morrow, et. al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy Circulation.2000; 102: 2031-2037 doi: 10.1161/01.CIR.102.17.2031
5. Emerg Med J 2008;25:122

    5.Chesebro, J. H., G. Knatterud, R. Roberts, J. Borer, L. S. Cohen, J. Dalen, H. T. Dodge, C. K. Francis, D. Hillis, and P. Ludbrook. "Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A Comparison between Intravenous Tissue Plasminogen Activator and Intravenous Streptokinase. Clinical Findings through Hospital Discharge." Circulation 76.1 (1987): 142-54. American Heart Association - Circulation. Web. 17 July 2015.

External links

• TIMI Score for iPhone
• TIMI Website
• ClinicalTrials.gov website
• Interactive versions of TIMI Risk Score for UA/NSTEMI, TIMI Risk Score for STEMI, and TIMI Risk Index as per TIMI Study Group guidelines