This score was NOT developed in the emergency department. It was initially developed for prognostication in patients with known NSTEMI / UA.
Risk factors for CAD: HTN, HLD, DM, family history of CAD, or current smoker
Risk at 14 days of all cause mortality:
- 0-1: 5% (in ADAPT trial, TIMI 0 → 1.2% risk of MACE at 30 days)
- 2: 8%
- 3: 13%
- 4: 20%
- 5: 26%
- 6-7: 41%
ADAPT Protocol:
- EKG demonstrating no new ischemic changes
- High-sensitivity troponin-I is negative at 0 and 2h
- TIMI score 0 → Sens. 100% (CI 98.5-100%), NPV 100% (98.8-100%)
- TIMI score 1 → Sens. 99.2% (CI 97.1-99.8%), NPV 99.7% (98.9-99.9%)
- Outcomes: Major Adverse Cardiac Events (MACE) at 30 days [death, AMI, cardiac arrest, emergency revascularization, cardiogenic shock, ventricular arrhythmia, high-degree AV block]
Antman EM 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):835-42.
Than M et. al. 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker: The ADAPT Trial. J Am Coll Cardiol. 2012; 59(23): 2091-8. Text
Cullen L et al. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol. 2013; 62(14):1242-9. Text