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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Abstract
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 |
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Status: | Published |
Refereed: | Yes |
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: | 2352-9067 |
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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