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Acute coronary syndromes
Use of risk scores in acute coronary syndromes
  1. Héctor Bueno,
  2. Francisco Fernández-Avilés
  1. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  1. Correspondence to Dr Héctor Bueno, Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr Esquerdo, 46, Madrid 28007, Spain; hecbueno{at}jet.es

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Risk is defined as the probability and severity of loss from exposure to a hazard, and can be assessed in different ways. The application of quantitative or qualitative measures to determine the level of risk associated with a specific hazard defines the process of risk assessment. Qualitative risk assessments (ie, high, intermediate or low risk) are based on the presence or absence of certain characteristics (risk markers or factors). These are easy to use but not accurate as there may be wide variations in individual risk within risk subgroups. Quantitative risk assessments, based on algorithms or mathematical formulae, are more precise but more complicated to use. Risk scores are formula generated numbers used for quantitative risk assessment that rank-order individuals according to the likelihood of developing a specific outcome (or combination of outcomes) during a defined time interval.

Acute coronary syndromes (ACS) are clinical entities characterised by acute symptomatic myocardial ischaemia that has not been triggered by stimuli causing a significant increase of the demand for oxygen by the heart. ACS are usually caused by acute thrombosis of a coronary artery, most frequently associated with lesions caused by chronic coronary atherosclerosis. According to the initial ECG, ACS are classified as presenting with ST segment elevation or non-ST segment elevation. This article will focus on non-ST segment elevation ACS.

The clinical consequences of ACS range from none or minimal sequelae to early death. Patients with ACS have a relatively high incidence of cardiac events in the short term, particularly myocardial ischaemic recurrences—recurrent angina or myocardial infarction (MI)—but also heart failure, arrhythmias and other events, which may also lead to future further complications. For this reason, ACS require an early pharmacological treatment—based on antithrombotic therapies, …

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