The TIMI (Thrombolysis in Myocardial Infarction) trialists developed a score to predict adverse outcomes in patients with unstable angina1. The score was validated among patients admitted to specialist cardiological services, a group who are likely to be at higher risk of significant cardiac events than those presenting to an emergency department. The objectives of this study were to determine the relationship between TIMI score and outcomes in an undifferentiated chest pain population and to define the validity of the score without the troponin component, the “front door” score.
The study took place in a single urban teaching hospital emergency department with 85 000 adult attendances yearly. One thousand consecutive patients presenting with potentially cardiac chest pain were enrolled. Exclusion criteria were age less than 20 years and the initial assessing clinician’s judgement that chest pain was of a non-cardiac nature. Several variables were determined and recorded on a structured form. Patients were followed up to hospital discharge or 30 days after enrolment.
TIMI scores were then calculated for each patient. The TIMI score consists of seven elements, each scoring one point. The elements are age ⩾ 65 years, three or more risk factors for coronary artery disease, known coronary artery stenosis, use of aspirin for the past seven days or more, raised cardiac markers, ⩾ 0.5 mm deviation of the ST …