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Do we need early risk stratification after ST-elevation myocardial infarction?
  1. Peter McLeod1,2,
  2. Philip D Adamson3,4,
  3. Sean Coffey1,2
  1. 1 Department of Medicine - HeartOtago, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
  2. 2 Department of Cardiology, Southern District Health Board, Dunedin, New Zealand
  3. 3 Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
  4. 4 British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Sean Coffey, Department of Medicine - HeartOtago, University of Otago Dunedin School of Medicine, Dunedin 9016, New Zealand; scoffey{at}

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Despite significant advances in the treatment of ST elevation myocardial infarction (STEMI), there remains a significant short-term and long-term increased mortality risk. Risk stratification to target those who may benefit from more intensive therapy postrevascularisation therefore remains an important goal.

Risk stratification models in acute coronary syndrome (ACS) have been researched for many years, but few risk scores have been developed and validated specifically for the STEMI population. Only 27% of the cohort for the Global Registry of Acute Coronary Events (GRACE) score was derived from those undergoing percutaneous intervention (PCI), and the GRACE score performs less accurately in those undergoing PCI compared with medical therapy. Nevertheless European1 (but not American2) guidelines recommend its use for clinical risk stratification in the STEMI cohort. Risk scores derived specifically for STEMI include the Global Utilization of Streptokinase and Tissue plasminogen activator to treat Occluded arteries (GUSTO) risk score, which was developed in the era of thrombolysis, while risk scores assessing mortality in primary PCI patients include the Primary Angioplasty in Myocardial Infarction (PAMI) risk score, Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score, Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) score, Soroka Acute Myocardial Infarction (SAMI) score, and the Zwolle risk score.

Coelho-Lima and colleagues3 examine the prognostic value of troponin specifically in the STEMI population, a group where troponin is not used to guide initial treatment. Their major findings are that admission troponin, but not troponin measured 12 hours post-reperfusion, was a significant independent predictor of both inpatient or overall mortality, with a median follow-up time of over 4 years. The authors are to be commended for this large retrospective study—in particular, the clinical …

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  • Contributors PM wrote the first draft. All authors made substantial contributions to the conception of the work. All authors revised the work and gave final approval for it to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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