Risk Stratification of Patients with Acute Coronary Syndrome

Defining the risk factors affecting the prognosis of patients with acute coronary syndrome (ACS) has been a challenge. Many individual biomarkers and risk scores that predict outcomes during different periods following ACS have been proposed. This review evaluates known outcome predictors supported by clinical data in light of the development of new treatment strategies for ACS patients during the last three decades.

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Dickkopf-1 as a Novel Predictor Is Associated with Risk Stratification by GRACE Risk Scores for Predictive Value in Patients with Acute Coronary Syndrome: A Retrospective Research

PLoS ONE ◽

10.1371/journal.pone.0054731 ◽

2013 ◽

Vol 8 (1) ◽

pp. e54731 ◽

Cited By ~ 24

Author(s):

Lin Wang ◽

Xiao Bo Hu ◽

Wei Zhang ◽

Lin Di Wu ◽

Yu Sheng Liu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Stratification ◽

Predictive Value ◽

Risk Scores ◽

Coronary Syndrome ◽

Dickkopf 1

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HIGH RISK STRATEGY EFFICACY IN PROGNOSIS OF PRIMARY ONSET OF ISCHEMIC HEART

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2014-6-38-43 ◽

2014 ◽

Vol 13 (6) ◽

pp. 38-43

Author(s):

I. S. Skopets ◽

N. N. Vesikova ◽

L. L. Bershtein

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Cardiovascular Risk ◽

Primary Prevention ◽

Coronary Vessels ◽

Ischemic Heart ◽

Risk Scores ◽

High Morbidity ◽

Coronary Syndrome ◽

Calculated Risk

High morbidity and mortality from ischemic heart disease (CHD) in RF presupposes the significance of individual prognosis of cardiovascular risk and of primary prevention.Aim.To analyze the level of risk that could be calculated in patients with CHD debut just before the manifest of the disease and therefore to evaluate the opportunities for the CHD debut by standard scores; to evaluate the relation of a real volume of primary prevention events to current Guidelines.Material and methods.In 122 patients hospitalized with CHD debut as an acute coronary syndrome, a retrospective cardiovascular risk evaluation, which could be found just before the onset of the disease.Results.The prevalence of traditional risk factors among persons with CHD onset was high: 88% patients had ≥3 risk factors. However, before the onset of acute coronary syndrome 68% patients at Framingham scale and 47% by SCORE could have been under the low and moderate calculated risk that shows low sensitivity for the real CHD risk. Calculated risk by the scores has not correlated with the severity of coronary vessels lesion. In analysis of primary prevention events in was found that in the studied group drug therapy of dyslipidemia was not being performed as primary prevention, though it is indicated by the standards for at least 82% patients.Conclusion.The data shows that the use of the main risk scores underestimates real chance of CHD development in the exact patient. Also even for the patients, who require statin prescription for the aim of primary prevention, this therapy is not prescribed.

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Gender-related Differences in Risk factors and Treatment Strategies in Patients with Acute Coronary Syndrome across Egypt: part of the Cardio- Risk Project

Atherosclerosis Supplements ◽

10.1016/j.atherosclerosissup.2018.07.045 ◽

2018 ◽

Vol 33 ◽

pp. e2

Author(s):

Ashraf Reda ◽

Mohamed Ashraf ◽

Mahmoud Soliman ◽

Hany Ragy ◽

Ahmed Elkersh ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Treatment Strategies ◽

Coronary Syndrome

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The Implications of Diabetes Mellitus on the Pattern of Risk factors Profile and treatment strategies in Patients with Acute Coronary Syndrome

Atherosclerosis Supplements ◽

10.1016/j.atherosclerosissup.2018.07.050 ◽

2018 ◽

Vol 33 ◽

pp. e3-e4

Author(s):

Ashraf Reda ◽

Atef Elbahry ◽

Elsayed Farag ◽

Hazem Khamis ◽

Mohamed Ashraf

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Acute Coronary Syndrome ◽

Treatment Strategies ◽

Coronary Syndrome

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ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01841-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ivica Kristić ◽

Nikola Crnčević ◽

Frane Runjić ◽

Vesna Čapkun ◽

Ozren Polašek ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Score ◽

Treatment Strategies ◽

Risk Scores ◽

Coronary Syndrome ◽

Long Term Follow Up ◽

St Elevation ◽

All Treatment

Abstract Background Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up. Methods Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. Results During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00–1.05, P = 0.023 and HR 2.02, 95% CI 1.04–3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36–3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively). Conclusions ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.

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Risk Assessment Using Risk Scores in Patients with Acute Coronary Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm9093039 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3039 ◽

Cited By ~ 1

Author(s):

Dean Chan Pin Yin ◽

Jaouad Azzahhafi ◽

Stefan James

Keyword(s):

Risk Assessment ◽

Acute Coronary Syndrome ◽

Treatment Options ◽

Treatment Strategies ◽

Treatment Decision ◽

Bleeding Risk ◽

Risk Scores ◽

Cardiac Events ◽

Post Discharge ◽

Coronary Syndrome

Risk scores are widely used in patients with acute coronary syndrome (ACS) prior to treatment decision-making at different points in time. At initial hospital presentation, risk scores are used to assess the risk for developing major adverse cardiac events (MACE) and can guide clinicians in either discharging the patients at low risk or swiftly admitting and treating the patients at high risk for MACE. During hospital admission, risk assessment is performed to estimate mortality, residual ischemic and bleeding risk to guide further in-hospital management (e.g., timing of coronary angiography) and post-discharge management (e.g., duration of dual antiplatelet therapy). In the months and years following ACS, long term risk can also be assessed to evaluate current treatment strategies (e.g., intensify or reduce pharmaceutical treatment options). As multiple risk scores have been developed over the last decades, this review summarizes the most relevant risk scores used in ACS patients.

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Registry Study of Clinical Data and in Hospital Outcome in Patients Admitted with Acute Coronary Syndrome at Tanta University Hospital in 2019

Cardiology and Angiology An International Journal ◽

10.9734/ca/2020/v9i430151 ◽

2020 ◽

pp. 65-77

Author(s):

Doaa Abdelfattah Helal ◽

Fatma Aboalsaoud Taha ◽

Sameh Samir Khalel ◽

Mohammed Elsayed El Setiha

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Risk Stratification ◽

Previous History ◽

University Hospital ◽

Hospital Death ◽

Killip Class ◽

Hospital Outcome ◽

Coronary Syndrome ◽

History Of

Background: A quick but thorough assessment of the patient’s history and findings on physical examination, electrocardiography, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification. This work aimed to analyze the diagnostic and prognostic tools, the modalities of management, and the hospital outcome of patients with acute coronary syndrome (ACS) at Tanta University Hospital in one year. Methods: This ACS registry at Tanta university hospital is a prospective observational registry for 200 consecutive admitted patients with proven ACS from January 2019 to January 2020. Results: A higher percent of hypertension, family history of ischemic heart disease and SCD, previous history of chronic kidney disease (CKD), and lower percent of a previous history of IHD in STEMI compared to NSTEMI/UA. In-hospital death, in-hospital reinfarction, and reduced ejection fraction are higher in STEMI than in NSTEMI/UA patients. (P value = 0.015, 0.018 and 0.001 respectively) without significant differences regarding in-hospital congestive heart failure (CHF) and ischemic stroke. History of CKD, higher Killip class, and in-hospital stroke were independently affecting in-hospital mortality. Also, the history of higher Killip class was independently affecting in-hospital reinfarction and in-hospital CHF. Old age and occurrence of in-hospital reinfarction were independently affecting in-hospital stroke. Conclusion: Hypertension, diabetes, dyslipidemia, and smoking are the major risk factors for ACS so, controlling these risk factors will improve in-hospital outcomes. In STEMI, most patients underwent PPCI, which was reflected in the outcome. In NSTEMI/UA patients, both conservative and invasive management was done, taking into consideration the risk stratification of each patient, making management easier and with a good outcome.

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