Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment
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...
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| Format: | Article |
| Language: | English |
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Elsevier
2015-09-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906715300129 |
| _version_ | 1819077760288555008 |
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| author | David Corcoran Patrick Grant Colin Berry |
| author_facet | David Corcoran Patrick Grant Colin Berry |
| author_sort | David Corcoran |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T19:02:19Z |
| format | Article |
| id | doaj.art-001dd4dece8645deb0124cbd74b4cf32 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-21T19:02:19Z |
| publishDate | 2015-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-001dd4dece8645deb0124cbd74b4cf322022-12-21T18:53:27ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672015-09-018C13113710.1016/j.ijcha.2015.06.009Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgmentDavid Corcoran0Patrick Grant1Colin Berry2West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, UKDepartment of Emergency Medicine, Glasgow Royal Infirmary, G4 0SF, UKWest of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, UKUndifferentiated 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.http://www.sciencedirect.com/science/article/pii/S2352906715300129NSTE-ACSRisk stratificationMyocardial infarctionGRACE score |
| spellingShingle | David Corcoran Patrick Grant Colin Berry Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment International Journal of Cardiology: Heart & Vasculature NSTE-ACS Risk stratification Myocardial infarction GRACE score |
| title | Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment |
| title_full | Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment |
| title_fullStr | Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment |
| title_full_unstemmed | Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment |
| title_short | Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment |
| title_sort | risk stratification in non st elevation acute coronary syndromes risk scores biomarkers and clinical judgment |
| topic | NSTE-ACS Risk stratification Myocardial infarction GRACE score |
| url | http://www.sciencedirect.com/science/article/pii/S2352906715300129 |
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