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TIMI risk score for UA/NSTEMI: how the seven points are counted

The TIMI risk score for unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI) gives 1 point for each of seven findings that are present. The total runs from 0 to 7.

Not a medical device. Not a diagnosis or dosing recommendation.

Use this calculator via API

What is the TIMI risk score for UA/NSTEMI?

The score comes from Elliott Antman and colleagues, who described it in JAMA in 2000. Their abstract says each factor scores 1 when present and 0 when absent, and the factors are added up. It was built from patients in two large trials of unstable angina and NSTEMI.

There's a separate TIMI risk score for STEMI, with different items. This page covers the UA/NSTEMI version.

This page explains the arithmetic. Magent's calculator returns the total out of 7. It doesn't return an event-rate table, and this page doesn't say what a total means for a particular person.

The TIMI UA/NSTEMI formula

TIMI = age 65 or older (1)
     + 3 or more CAD risk factors (1)
     + known CAD, stenosis 50% or more (1)
     + aspirin in the last 7 days (1)
     + severe angina, 2 or more episodes in 24 hours (1)
     + ST deviation of 0.5 mm or more (1)
     + elevated cardiac markers (1)
maximum = 7

Exact expression the calculator uses:

TIMI UA/NSTEMI = age_ge_65 + cad_risk_factors_ge_3 + known_cad + aspirin_last_7d + severe_angina + st_deviation + elevated_markers; each 1 if present; max 7

What each item means

InputScores 1 point when
ageAge is 65 or older (the calculator takes age 18 to 120 and scores it)
cad_risk_factors_ge_33 or more coronary artery disease (CAD) risk factors, as you assign them
known_cadKnown CAD, with stenosis of 50% or more
aspirin_last_7dAspirin taken in the last 7 days
severe_anginaSevere angina: 2 or more episodes in 24 hours
st_deviationST deviation of 0.5 mm or more, as you assign it
elevated_markersElevated cardiac markers, as you assign them

How the score works

  1. Score age. 65 or older is 1 point; younger is 0. The calculator does this from the age in years.
  2. Mark the six other items. Each is true or false. True is 1 point.
  3. Add them up. The total is 0 to 7.

Inputs come from the user

Six of the seven items are yes/no flags that the person using the calculator sets. Magent's calculator doesn't count risk factors for you; it doesn't break them down into smoking, hypertension, family history, diabetes or cholesterol. It doesn't read an ECG. It returns the total, the maximum of 7, the age it used and a line for each item.

Worked examples

These use Magent's own expected values for the calculator. Each line adds the items in the order of the formula: age, risk factors, known CAD, aspirin, severe angina, ST deviation, markers.

Example 1: age 50, no items

  1. Age 50 is under 65 → 0.
  2. Score: 0 + 0 + 0 + 0 + 0 + 0 + 0 = 0 out of 7.

Example 2: age 65, no other items

  1. Age 65 is 65 or older → 1.
  2. Score: 1 + 0 + 0 + 0 + 0 + 0 + 0 = 1 out of 7.

Example 3: age 50, risk factors, known CAD and aspirin

  1. Age 50 → 0.
  2. Score: 0 + 1 + 1 + 1 + 0 + 0 + 0 = 3 out of 7.

Example 4: age 80, every item present

  1. Age 80 → 1.
  2. Score: 1 + 1 + 1 + 1 + 1 + 1 + 1 = 7 out of 7, the maximum.

History of the TIMI risk score

The score comes from Antman EM, Cohen M, Bernink PJLM and colleagues, writing in JAMA in 2000 (volume 284, issue 7, pages 835–842). The abstract lists the seven predictor variables and describes building the score in one group of trial patients, then checking it in other groups, including patients from the ESSENCE trial.

Scirica and colleagues looked at the score in the TIMI III registry in the American Journal of Cardiology in 2002.

Pollack and colleagues applied it to an unselected emergency department chest pain population in Academic Emergency Medicine in 2006.

When it's used

The 2000 paper studied people with unstable angina or NSTEMI. The 2014 AHA/ACC guideline for non-ST-elevation acute coronary syndromes and the 2025 ACC/AHA/ACEP/NAEMSP/SCAI acute coronary syndrome guideline are listed under Further reading.

Where it's used

The inputs come from the history, an ECG and blood tests. The 2006 paper looked at the score in an emergency department.

Who uses it

The person using the calculator sets the six yes/no items. The calculator scores age and adds the points.

Limits of the calculation

  • It adds up seven items. It doesn't confirm or rule out a heart attack, and it isn't a protocol for an invasive strategy.
  • Six of the items are flags you set. The calculator doesn't count risk factors or read an ECG.
  • It returns a total, not an event rate.
  • It's the UA/NSTEMI score, not the TIMI score for STEMI.
  • This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

  • TIMI risk score for STEMI is a separate TIMI score with different items and weights.
  • HEART score gives 0, 1 or 2 points to each of five parts: history, ECG, age, risk factors and troponin.

Glossary

  • Unstable angina (UA): chest pain from reduced blood flow to the heart that is new, worsening or at rest.
  • NSTEMI: a heart attack without ST elevation on the ECG.
  • CAD: coronary artery disease.
  • Stenosis: narrowing of an artery.
  • ST deviation: a shift up or down in one part of the ECG tracing.
  • Cardiac markers: blood tests for heart muscle injury, such as troponin.

Common mistakes

  • Scoring age below 65. Age scores from 65.
  • Counting each risk factor as a point. Three or more risk factors together are 1 point.
  • Using the STEMI version. The STEMI score has different items.
  • Expecting more than 7. Every item is worth 1 point, so 7 is the top.

Source

Antman EM, Cohen M, Bernink PJLM, 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):835-842. DOI: 10.1001/jama.284.7.835. PMID: 10938172

Further reading

  1. Scirica BM, et al. Validation of the thrombolysis in myocardial infarction (TIMI) risk score for unstable angina pectoris and non-ST-elevation myocardial infarction in the TIMI III registry. Am J Cardiol. 2002;90(3):303-305. PMID: 12127617
  2. Pollack CV Jr, et al. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med. 2006;13(1):13-18. PMID: 16365321
  3. Amsterdam EA, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-e426. PMID: 25249585
  4. Rao SV, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-e862. PMID: 40014670

Frequently asked questions

How do you calculate the TIMI risk score for UA/NSTEMI?

Give 1 point for age 65 or older and 1 point for each of the six other items that is present. Add them up for a total from 0 to 7.

What is a high TIMI score?

The calculator returns a total from 0 to 7 and no band or event rate. Higher totals mean more items are present. What a total means for a particular person depends on the person and the clinical context.

What is the highest TIMI score for UA/NSTEMI?

7, when all seven items are present.

Is this the same as the TIMI score for STEMI?

No. The STEMI score is separate, with different items.

Does the calculator read the ECG?

No. You set the ST deviation item yourself.