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Is there still a place for improvement in acute coronary syndrome risk stratification?
  1. Ana Teresa Timóteo
  1. 1Santa Marta Hospital, CHLC, Lisbon, Portugal
  2. 2NOVA Medical School, Lisbon, Portugal
  3. 3Working Group on Intensive Cardiac Care of the Portuguese Society of Cardiology, Lisbon, Portugal
  1. Correspondence to Professor Ana Teresa Timóteo, Hosp Santa Marta, Rua Santa Marta, Lisbon 1120, Portugal; ana_timoteo{at}yahoo.com

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In ST-elevation myocardial infarction (STEMI), early diagnosis by the specific ECG changes and timely reperfusion therapy, has remarkably improved the outcome. The non-ST-elevation acute coronary syndrome (NSTEACS) cohort is usually larger and more heterogeneous. Given the wide spectrum of antithrombotic and antiplatelet therapies available today, as well as improvements in invasive management, it requires a timely management decision by physicians. Although these therapeutic options improve outcome, they can increase both the rate of complications and costs. For that reason, an informed decision is important and risk stratification scores are helpful tools for an early triage and adequate identification of intermediate/high-risk groups that can benefit from an invasive strategy.

In the last 15 years, several risk stratification scores for acute coronary syndromes (ACSs) have been developed. The first risk scores to be widely implemented in clinical practice were Thrombolysis in Myocardial Infarction risk score for STEMI and NSTEACS.1 ,2 These scores were developed from cohorts of patients included in randomised clinical trials. Subsequent risk scores used the same methodology. Global Registry of Acute Coronary Events (GRACE) risk score was published in 2003 by the GRACE registry group, initially for hospital mortality in patients with ACS and later on for 6-month mortality.3 ,4 This score was developed from a registry that represents real-world patients instead of the highly controlled and selected population found in clinical trials, which is considered a limitation of previous risk scores. Elderly patients and patients with severe renal dysfunction are usually excluded from clinical trials. This might explain the inclusion of new variables such as renal function in the new real-life score. …

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