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Without special treatment, some people with unstable angina are more likely than others to get worse chest pain, to have a heart attack or to die. But these risks can be reduced with intensive drug treatment, a procedure to widen the coronary arteries, or both.^{1 2}

That's why it's very important for doctors to figure out your risk for getting worse. Your risk can change in the hours after your attack. So your doctor will watch you closely during this time.

One way doctors commonly measure risk for people with unstable angina is to use something called the TIMI risk scale.^{1 2} On this scale, the more points you have, the higher your risk. You get 1 point for each of the seven things below that apply to you.

• You are 65 or older.
• You have three or more risk factors for coronary artery disease. For more on risk factors, see What is unstable angina?
• One of your coronary arteries is narrowed by half (50 percent) or more.
• You have a change of more than 0.5 millimeters on a part of your electrocardiogram (ECG) called the ST segment. The bigger the change, the more likely it is that you have heart muscle damage. For more, see Electrocardiogram.
• You had two or more angina attacks in the 24 hours before you went to the hospital.
• You have an increase in your blood levels of a substance called troponin or of other substances that show your heart muscle is damaged. For more, see Troponin test.
• You used aspirin in the seven days before you went to the hospital. Taking aspirin should lower your risk of getting blood clots that could block your coronary arteries. But if you still get unstable angina, even though you took aspirin, the drug may not be working because your arteries are too narrow.

If you score 3 or higher on the TIMI risk scale, your doctor will probably advise you to do the following things.¹

• Have a test called coronary angiography, to see if your coronary arteries are very narrow.
• If necessary, have a procedure to widen the arteries or an operation to get blood flowing around the blockage, ideally within 24 hours of getting to the hospital.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.