As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. ST-segment deviation of ≥0.Background: The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI).Severe angina (e.g., >2 angina events in past 24 h or persisting discomfort) (1 point).Significant coronary stenosis (stenosis >50%) (1 point).Use of aspirin in the past 7 days (1 point).family history of coronary artery disease. Three or more risk factors for coronary artery disease: (1 point).Slightly elevated cardiac TnT, TnI, or CK-MB (e.g., TnT >0.01 but 65 yrs (1 point) T-wave changes, pathologic Q waves, or resting ST depression 0.1 nanogram/mL) New or worsening mitral regurgitation murmurĪngina at rest with transient ST-segment changes >0.5 mm Pulmonary edema, most likely due to ischemia New-onset or progressive Canadian Cardiology Society Class III or IV angina in the past 2 wk without prolonged (>20 min) rest pain but with intermediate or high likelihood of CAD New-onset angina with onset 2 wk to 2 mo before presentation Rest angina (>20 min) or relieved with rest or sublingual nitroglycerin Increased angina frequency, severity, or duration Prolonged (>20 min) rest angina, now resolved, with moderate or high likelihood of CAD Prior myocardial infarction, peripheral or cerebrovascular disease, or coronary artery bypass grafting prior aspirin use Low Likelihood (no high- or intermediate-risk feature, but may have any of the following)Īccelerating tempo of ischemic symptoms in preceding 48 h Intermediate Likelihood (no high-risk feature, but must have one of the following) High Likelihood (at least one of the following features must be present) New, or presumably new, transient ST-segment deviation (1 mm or greater) or T-wave inversion in multiple precordial leadsĮlevated cardiac troponin I, troponin T, or MB fraction of creatine kinaseĬomposite Outcome: Death or Nonfatal Myocardial Infarction by Risk Stratification in Patients with Unstable Angina Feature Transient mitral regurgitation murmur, hypotension, diaphoresis, pulmonary edema, or rales Known history of coronary artery disease, including myocardial infarction Probable ischemic symptoms in absence of any of the intermediate-likelihood characteristics Low Likelihood (absence of high- or intermediate-likelihood features but may have)Ĭhest or left arm pain or discomfort as chief symptom reproducing prior documented anginaĬhest or left arm pain or discomfort as chief symptom Intermediate Likelihood (absence of high-likelihood features and presence of any of the following) Likelihood That Signs/Symptoms Represent ACS due to CAD Feature
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