American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT a criterion for the TIMI Risk Score?

1. Age ≥65 years

2. History of myocardial infarction

3. Documented CAD with ≥50% diameter stenosis

4. Elevated cardiac biomarkers

The correct answer is: History of myocardial infarction

The TIMI Risk Score is a clinical tool used to assess the risk of adverse outcomes in patients with unstable angina and non-ST elevation myocardial infarction (NSTEMI). Each of the criteria listed is based on factors that increase the likelihood of significant cardiac events within a specific timeframe. A history of myocardial infarction is actually a significant criterion within the TIMI Risk Score. It contributes to the overall risk assessment because a prior myocardial infarction indicates pre-existing coronary artery disease and a higher likelihood of further events. In contrast, documented coronary artery disease (CAD) with ≥50% diameter stenosis is explicitly included in the TIMI Risk Score assessment. This measure indicates a notable degree of blockage in the arteries, which significantly raises the risk for future cardiac events. Elevated cardiac biomarkers are also a part of the TIMI Risk Score. Biomarkers such as troponins are indicative of myocardial injury and can help predict an increased risk of adverse outcomes. Age ≥65 years is included in the score because older patients generally face higher cardiovascular risk, making their inclusion essential for evaluating risk effectively. The lack of a history of myocardial infarction as a criterion, rather than its presence, would thus be the correct understanding as it does not appear in the TIMI