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Abstract

Patients who present with ACS should continually undergo risk stratification throughout their hospitalization. Risk stratification is synonymous with prognosis determination: patients who have the highest risk will also have the poorest prognosis. This process begins at the moment of initial medical contact, proceeds throughout hospitalization and continues thereafter. The process of risk stratification channels intensive medical care to those who are most in need, while reserving more conservative therapy for patients at lower risk. This process is essential since intensive medical care can produce its own side effects. Such side effects may be acceptable in patients at highest risk, although in lower risk populations they will become unattractive.

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References

  1. Savonitto S, Ardissino D, Granger CB, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA 1999; 281:707–713.

    Article  Google Scholar 

  2. Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335:1342–1349.

    Article  Google Scholar 

  3. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000; 284:835–842.

    Article  Google Scholar 

  4. Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001; 344:1879–1887.

    Article  Google Scholar 

  5. de Araujo Goncalves P, Ferreira J, Aguiar C, et al. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J 2005; 26:865–872.

    Article  Google Scholar 

  6. 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. The PURSUIT Investigators. Circulation 2000; 101:2557–2567.

    Article  Google Scholar 

  7. Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003; 163:2345–2353.

    Article  Google Scholar 

  8. Bhatt DL. To cath or not to cath: that is no longer the question. JAMA 2005; 293:2935–2937.

    Article  Google Scholar 

  9. Bhatt DL, Roe MT, Peterson ED, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA 2004; 292:2096–2104.

    Article  Google Scholar 

  10. Fox KA, Anderson FA, Jr., Dabbous OH, et al. Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE). Heart 2007; 93:177–182.

    Article  Google Scholar 

  11. Lee KL, Woodlief LH, Topol EJ, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation 1995; 91:1659–1668.

    Article  Google Scholar 

  12. Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000; 102:2031–2037.

    Article  Google Scholar 

  13. Negassa A, Monrad ES, Bang JY, et al. Tree-structured risk stratification of in-hospital mortality following percutaneous coronary intervention for acute myocardial infarction. Am Heart J 2007; 154:322–329.

    Article  Google Scholar 

  14. Bavry AA, Bhatt DL. Designing the ideal risk model for acute coronary syndromes-is simple better than complex? Am Heart J 2007; 154:206–207.

    Article  Google Scholar 

  15. Bavry AA, Mood GR, Kumbhani DJ, et al. Long-term benefit of statin therapy initiated during hospitalization for an acute coronary syndrome: a systematic review of randomized trials. Am J Cardiovasc Drugs 2007; 7:135–141.

    Article  Google Scholar 

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© 2008 Current Medicine Group, a part of Springer Science+Business Media

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Bavry, A.A., Bhatt, D.L. (2008). Risk stratification. In: Managing Acute Coronary Syndromes in Clinical Practice. Springer Healthcare, Tarporley. https://doi.org/10.1007/978-1-908517-14-2_4

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