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

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

Blog Article

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 Bridesmaids 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 Lycopene 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.