Risk stratification in non-ST elevation acute coronary syndromes: risk scores, biomarkers and clinical judgment

Corcoran, D., Grant, P. and Berry, C. (2015) Risk stratification in non-ST elevation acute coronary syndromes: risk scores, biomarkers and clinical judgment. International Journal of Cardiology: Heart and Vasculature, 8, pp. 131-137. (doi: 10.1016/j.ijcha.2015.06.009) (PMID:26753174) (PMCID:PMC4691930)

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Undifferentiated chest pain is one of the most common reasons for emergency department attendance and admission to hospitals. Non-ST elevation acute coronary syndrome (NSTE-ACS) is an important cause of chest pain, and accurate diagnosis and risk stratification in the emergency department must be a clinical priority. In the future, the incidence of NSTE-ACS will rise further as higher sensitivity troponin assays are implemented in clinical practice. In this article, we review contemporary approaches for the diagnosis and risk stratification of NSTE-ACS during emergency care. We consider the limitations of current practices and potential improvements. Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE) risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom), in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Corcoran, Dr David and Berry, Professor Colin
Authors: Corcoran, D., Grant, P., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:International Journal of Cardiology: Heart and Vasculature
Publisher:Elsevier B.V.
ISSN (Online):2352-9067
Published Online:02 July 2015
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in IJC Heart & Vasculature
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
575371Fractional Flow Reserve versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes: a Developmental Clinical StudyColin BerryBritish Heart Foundation (BHF)PG/11/55/28999RI CARDIOVASCULAR & MEDICAL SCIENCES