The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients

Abstract

Objective: To review the methods available for the risk stratification of non-ST elevation (NSTE) acute coronary syndrome (ACS) patients and to evaluate the use of risk scores for their initial risk assessment.

Data sources: The data of the present review were identified by searching PUBMED and other databases (1996 to 2008) using the key terms "risk stratification", "risk scores", "NSTEMI", "UA" and "acute coronary syndrome".

Study selection: Mainly original articles, guidelines and critical reviews written by major pioneer researchers in this field were selected.

Result: After evaluation of several risk predictors and risk scores, it was found that estimating risk based on clinical characteristics is challenging and imprecise. Risk predictors, whether used alone or in simple binary combination, lacked sufficient precision because they have high specificity but low sensitivity. Risk scores are more accurate at stratifying NSTE ACS patients into low-, intermediate- or high-risk groups. The Global Registry of Acute Cardiac Events risk score was found to have superior predictive accuracy compared with other risk scores in ACS population. Treatments based according to specific clinical and risk grouping show that certain benefits may be predominantly or exclusively restricted to higher risk patients.

Conclusion: Based on the trials in the literature, the Global Registry of Acute Cardiac Events risk score is more advantageous and easier to use than other risk scores. It can categorize a patient's risk of death and/or ischemic events, which can help tailor therapy to match the intensity of the patient's NSTE ACS.

Keywords: Acute coronary syndrome; NSTEMI; Risk scores; Risk stratification; Unstable angina.