TIMI Risk Score for STEMI Calculator
The TIMI Risk Score tool by Bravo Calc provides accurate 30-day mortality risk assessment for patients with ST-elevation myocardial infarction (STEMI). This validated clinical decision support tool helps guide treatment strategies and patient management in acute coronary syndromes.
Patient Demographics
Risk Factors & Clinical Features
What is the TIMI Risk Score for STEMI?
The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for STEMI is a validated clinical prediction tool developed to estimate 30-day mortality risk in patients presenting with ST-elevation myocardial infarction. This evidence-based scoring system incorporates readily available clinical variables to provide rapid risk stratification at the bedside.
Originally derived from the InTIME-II trial database of over 15,000 STEMI patients, the TIMI Risk Score has been extensively validated across diverse populations and treatment strategies. The Bravo Calc TIMI tool implements this proven algorithm to support clinical decision-making in emergency departments, cardiac catheterization laboratories, and intensive care units worldwide.
The score ranges from 0 to 14 points, with higher scores indicating increased mortality risk. This risk stratification helps clinicians identify high-risk patients who may benefit from more aggressive interventions, closer monitoring, or specialized cardiac care pathways.
How to Use the TIMI Risk Score Calculator
Step 1: Patient Assessment
Gather essential clinical information including patient demographics, vital signs, medical history, and presentation details. Ensure accurate measurement of weight, blood pressure, and heart rate.
Step 2: Input Clinical Variables
Enter patient data into the Bravo Calc including age, cardiovascular risk factors, presentation characteristics, and hemodynamic parameters. All fields are clearly labeled with clinical definitions.
Step 3: Calculate Risk Score
Click calculate to obtain the TIMI Risk Score (0-14 points) and corresponding 30-day mortality risk percentage. The Bravo Calc provides immediate results with clinical interpretation.
Step 4: Clinical Decision Making
Use the risk stratification results to guide treatment intensity, monitoring requirements, and disposition decisions. Higher risk scores may warrant more aggressive interventions and specialized care.
TIMI Risk Score Components and Scoring
Age-Related Risk Factors
- Age 65-74 years: +2 points
- Age ≥75 years: +3 points
Advanced age is the strongest predictor of mortality in STEMI, reflecting decreased physiologic reserve and increased comorbidity burden.
Cardiovascular Risk Factors (1 point each)
- Diabetes mellitus: Known diabetes or admission glucose >180 mg/dL
- Hypertension: History of hypertension or BP >140/90 mmHg
- Angina pectoris: Prior history of angina
These traditional cardiovascular risk factors indicate underlying coronary artery disease severity and systemic atherosclerotic burden.
Presentation Characteristics
- Systolic BP <100 mmHg: +3 points
- Heart rate >100 bpm: +2 points
- Killip class II-IV: +2 points
- Weight <67 kg: +1 point
- Anterior ST elevation or LBBB: +1 point
- Time to treatment >4 hours: +1 point
These factors reflect hemodynamic compromise, infarct size, and treatment delays that impact prognosis.
TIMI Risk Score Calculator Formula
TIMI Risk Score = Sum of Individual Risk Factors
Age 65-74 years: 2 points
Age ≥75 years: 3 points
Diabetes mellitus: 1 point
Hypertension: 1 point
Angina: 1 point
Systolic BP <100 mmHg: 3 points
Heart rate >100 bpm: 2 points
Killip class II-IV: 2 points
Weight <67 kg: 1 point
Anterior STEMI or LBBB: 1 point
Time to treatment >4 hours: 1 point
Total Score Range: 0-14 points
The Bravo Calc automatically sums all applicable risk factors and provides the corresponding mortality risk percentage based on validated clinical data.
Clinical Examples and Risk Stratification
Example 1: Low Risk STEMI Patient
Patient: 55-year-old male, no diabetes, no hypertension
Presentation: Inferior STEMI, BP 130/80, HR 75, weight 80 kg
Treatment: Primary PCI within 2 hours
TIMI Score: 0 points
30-day mortality: 0.8%
Clinical significance: Excellent prognosis, standard care appropriate
Example 2: Intermediate Risk STEMI Patient
Patient: 68-year-old female with diabetes and hypertension
Presentation: Anterior STEMI, BP 110/70, HR 95, weight 65 kg
Treatment: Thrombolysis at 3 hours
TIMI Score: 6 points (Age 2 + DM 1 + HTN 1 + Anterior 1 + Weight 1)
30-day mortality: 7.3%
Clinical significance: Moderate risk, consider transfer for PCI
Example 3: High Risk STEMI Patient
Patient: 78-year-old male with diabetes, hypertension, prior angina
Presentation: Anterior STEMI, BP 85/50, HR 110, Killip class III
Treatment: Delayed presentation at 6 hours
TIMI Score: 12 points (Age 3 + DM 1 + HTN 1 + Angina 1 + SBP 3 + HR 2 + Killip 2 + Anterior 1 + Time 1)
30-day mortality: 35.2%
Clinical significance: Very high risk, aggressive intervention and ICU care required
Clinical Use Cases for TIMI Risk Score Calculator
Emergency Department
- Rapid risk stratification upon presentation
- Triage decisions for cardiac catheterization
- Transfer decisions to tertiary centers
- Family counseling and prognostic discussions
Cardiac Catheterization Lab
- Pre-procedural risk assessment
- Decision for mechanical circulatory support
- Post-PCI monitoring intensity
- Discharge planning considerations
Intensive Care Unit
- ICU admission criteria
- Monitoring intensity decisions
- Resource allocation planning
- Goals of care discussions
Clinical Research
- Patient stratification in trials
- Endpoint adjudication
- Quality improvement initiatives
- Benchmarking and outcomes research
Expert Tips for TIMI Risk Score Calculator
Accurate Data Collection
- Obtain accurate weight measurement or reliable estimate
- Document precise time of symptom onset and treatment initiation
- Assess Killip class systematically (pulmonary examination, vital signs)
- Verify diabetes history and check admission glucose levels
- Review ECG carefully for anterior involvement or new LBBB
Clinical Interpretation Guidelines
- Use TIMI score as one component of comprehensive clinical assessment
- Consider score in context of overall clinical presentation
- Higher scores warrant more aggressive monitoring and intervention
- Low scores don't eliminate need for standard STEMI care
- Reassess risk if clinical status changes significantly
Treatment Decision Support
- High-risk patients (score >8) may benefit from mechanical circulatory support
- Consider early invasive strategy regardless of thrombolytic eligibility
- Use score to guide intensity of post-procedural monitoring
- Factor risk score into discharge timing and follow-up planning
- Document score for quality metrics and outcome tracking
Frequently Asked Questions
How accurate is the TIMI Risk Score Calculator for STEMI?
The TIMI Risk Score has been extensively validated with excellent discrimination (C-statistic 0.78-0.84) across diverse populations. The Bravo Calc implements the original validated algorithm, providing reliable risk estimates that correlate well with observed 30-day mortality rates in clinical practice.
Can the TIMI score be used for NSTEMI patients?
No, this specific TIMI Risk Score is validated only for STEMI patients. A separate TIMI Risk Score Calculator exists for NSTEMI/unstable angina patients with different variables and scoring. The Bravo Calc TIMI tool is specifically designed for STEMI risk assessment.
What constitutes Killip class II-IV in the TIMI score?
Killip classification: Class I (no heart failure), Class II (rales, S3 gallop, elevated JVP), Class III (pulmonary edema), Class IV (cardiogenic shock). Classes II-IV receive 2 points in the TIMI score, reflecting hemodynamic compromise and increased mortality risk.
How should I handle missing data when calculating TIMI score?
The TIMI score requires complete data for accurate risk assessment. If critical variables are missing, make reasonable clinical estimates or obtain the information before calculating. The Bravo Calc will indicate which fields are required for valid score computation.
Does the TIMI score apply to patients receiving different treatments?
The TIMI score was originally derived from thrombolytic-treated patients but has been validated in primary PCI populations. Risk estimates remain accurate across different reperfusion strategies, making the Bravo Calc useful regardless of treatment approach.
What TIMI score threshold indicates high risk?
Generally, TIMI scores >8 indicate high risk (>30% 30-day mortality), scores 4-8 indicate intermediate risk (4-12% mortality), and scores 0-3 indicate low risk (<3% mortality). However, clinical judgment should always complement risk score interpretation.
How often should I recalculate the TIMI score?
The TIMI score is typically calculated once at presentation for initial risk stratification. However, if clinical status changes significantly (hemodynamic deterioration, development of heart failure), recalculation may provide updated prognostic information using the Bravo Calc.
Clinical Evidence and Validation Studies
Original Development Study
The TIMI Risk Score was derived from 15,078 STEMI patients in the InTIME-II trial, with validation in independent cohorts. The score demonstrated excellent discrimination and calibration across diverse patient populations and treatment strategies.
External Validation
Multiple studies have validated the TIMI Risk Score in different populations, including primary PCI patients, elderly populations, and international cohorts. Consistent performance across these studies supports the reliability of the Bravo Calc implementation.
Clinical Impact Studies
Implementation of TIMI Risk Score-guided care has been associated with improved risk stratification, more appropriate resource utilization, and enhanced clinical decision-making in acute coronary syndrome management programs.
References and Guidelines
1. Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation. Circulation. 2000;102(17):2031-2037.
2. Morrow DA, Antman EM, Parsons L, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA. 2001;286(11):1356-1359.
3. Wiviott SD, Morrow DA, Frederick PD, et al. Application of the Thrombolysis in Myocardial Infarction risk index in non-ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2006;47(8):1553-1558.
4. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127(4):e362-e425.
5. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119-177.
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Medical Disclaimer: The TIMI Risk Score Calculator by Bravo Calc is designed for educational and clinical decision support purposes. All calculations should be verified and interpreted by qualified healthcare professionals. This tool does not replace clinical judgment or comprehensive patient assessment. Always consider the complete clinical picture when making treatment decisions for STEMI patients.