Mind the Gap on ACS and the TIMI Risk Score

February 27, 2019

CORE IM Podcast 2 min read

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In this 2-part Mind the Gap episode, we explore – and pick apart – everything you thought you knew about unstable angina || By Steven R. Liu MD and Janine Knudsen MD || Graphic Design by Ramon Thompson || Peer Review Dr Norma Keller MD

Time Stamps

  • The basics – what is acute coronary syndrome? (4:08)
  • Clinical context matters – angina pectoris, atypical chest pain, and troponins (5:22)
  • You can’t just “cath” everyone – risk stratification to identify patients with high mortality risk (9:42)
  • TIMI isn’t perfect – the issues with the score and MACE outcomes (14:00)
  • Review of teaching points (17:58)

For a transcript of the podcast and show notes: https://www.coreimpodcast.com/2019/02/27/acute-coronary-syndrome-acs-and-the-timi-score/

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References

  • Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016;Jan 26.
  • Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. 2017; 135:e1–e458.
  • Amsterdam 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. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-e228.
  • Fred HL. Atypical chest pain: a typical humpty dumpty coinage. Tex Heart Inst J. 2009;36(5):373-4.
  • Lee TH, Cook EF, Weisberg M, et al. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med. 1985; 145:65–9.
  • Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci. 2012;4(1):65-93.
  • Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000 Jul 4;102(1):118-22.
  • Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000 Aug 16;284(7):835-42.