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Review
. 2009 Jun;25 Suppl A(Suppl A):29A-36A.
doi: 10.1016/s0828-282x(09)71051-7.

Explicit risk in acute coronary syndrome management

Merril L Knudtson  1 , Colleen M Norris, P Diane Galbraith, Jaro Hubacek, William A Ghali
Affiliations
Review

Explicit risk in acute coronary syndrome management

Merril L Knudtson et al. Can J Cardiol. 2009 Jun.

Abstract
in English, French

At least implicitly, most clinical decisions represent an integration of disease and treatment-based risk assessments. Often, as is the case with acute coronary syndrome (ACS), these decisions need to be made quickly at a time when data elements are limited, and published risk models are very useful in clarifying time-dependent determinants of risk. The present review emphasizes the value of explicit risk assessment and reinforces the fact that patients at highest risk are often those most likely to benefit from newer and more invasive therapies. Suggested ways to incorporate published ACS risk models into clinical practice are included. In addition, the need to adopt a longer-term view of risk in ACS patients is stressed, with particular regard to the important role of heart failure prediction and treatment.

Au moins implicitement, la plupart des décisions cliniques intègrent une évaluation de la maladie et du risque lié au traitement. Souvent, comme dans le cas du syndrome coronarien aigu (SCA), il faut prendre ces décisions rapidement à un moment ou les éléments de données sont limités, et les modèles de risque publiés sont très utiles pour clarifier les déterminants temporels du risque. La présente analyse fait ressortir l’intérêt de l’évaluation explicite du risque et le fait que les patients les plus vulnérables sont souvent ceux qui profiteront probablement le plus des thérapies plus récentes et plus effractives. On propose des moyens d’intégrer les modèles publiés de risque de SCA à la pratique clinique. De plus, on souligne la nécessité d’adopter une perspective à plus long terme du risque de SCA chez les patients, notamment le rôle important de la prévision et du traitement de l’insuffisance cardiaque.

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Figures

Figure 1)
Figure 1)
Mortality trends over one year for Global Use of Strategies To Open occluded arteries in acute coronary syndromes (GUSTO) IIb and Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) acute coronary syndrome (ACS) patients by ACS subgroup. The lines above the GUSTO bars indicate how the presence (upper dot) and absence (lower dot) of recurrent severe ischemia in that registry strikingly influenced mortality (12). NSTEMI Non-ST segment elevation myocardial infarction; STEMI ST segment elevation myocardial infarction
Figure 2)
Figure 2)
Chart reflects the association of minimal, mild, moderate and severe physical limitation (Seattle Angina Questionnaire) with survival over time after diagnostic catheterization in consecutive consenting patients in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry (unpublished data)
See this image and copyright information in PMC

References

    1. Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation: Results from an international trial of 9461 patients. Circulation. 2000;101:2557–67. - PubMed
    1. Bungard TJ, Ghali WA, McAlister FA, et al. Physicians’ perceptions of the benefits and risks of warfarin for patients with nonvalvular atrial fibrillation. CMAJ. 2001;165:301–2. - PMC - PubMed
    1. Devereaux PJ, Ghali WA, Gibson NE, et al. Physician estimates of perioperative cardiac risk in patients undergoing noncardiac surgery. Arch Intern Med. 1999;159:713–7. - PubMed
    1. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1–157. - PubMed
    1. Stone PH, Thompson B, Anderson HV, et al. Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: The TIMI III registry. JAMA. 1996;275:1104–12. - PubMed