Journal
EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES
Volume 7, Issue 3, Pages 222-228Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ehjqcco/qcab018
Keywords
Acute coronary syndrome; Risk scores; Treatment; Prognosis
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This article highlights the importance of risk assessment in patients with ACS and the necessity of establishing and applying clinical risk scores for structured risk stratification. It also explores the role of risk scores in guiding clinical decision-making, particularly in the timing of invasive coronary angiography.
Patients with acute coronary syndromes (ACS), particularly non-ST-segment elevation ACS, represent a spectrum of patients at variable risk of short- and tong-term adverse clinical outcomes. Accurate prognostic assessment in this population requires the simultaneous consideration of multiple clinical and laboratory variables which may be under-recognized by the treating physicians, leading to an observed risk-treatment paradox in the use of invasive and pharmacological therapies. The routine application of established clinical risk scores, such as the Global Registry of Acute Coronary Events risk score, is recommended by major international clinical practice guidelines for structured risk stratification at the time of presentation, but uptake remains inconsistent. This article discusses the methodology of designing, deriving, and validating clinical risk scores, reviews the major validated risk scores for assessing prognosis in ACS, and examines their role in guiding clinical decision-making in ACS management, especially the timing of invasive coronary angiography. We also discuss emerging data on the impact of the routine use of such risk scores on patient management and clinical outcomes, as well as future directions for investigation in this this field.
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