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Coronary disease
Acute coronary syndromes: risk stratification


  1. Dr Adam D Timmis, Royal Hospitals Trust (London Chest Hospital), Bonner Road, London E2 9JX, UK email:adam{at}
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Timmis A
Acute coronary syndromes: risk stratification

Publication history

  • First published February 1, 2000.
Online issue publication 
February 01, 2000
  • Additional references for: Acute coronary syndromes: risk stratification. Timmis A.
    Heart 2000;83:241�6.

    Bayes de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: mechanisms of protection of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989;117:151�9.
    Epstein SE, Palmari ST, Patterson RE. Evaluation of patients after acute myocardial infarction: indications for cardiac catheterisation and surgical intervention. N Engl J Med 1982;307:1487�92.
    DeBusk RF, Glomqvist CG, Kouchoukos NT, et al. Identification and treatment of low-risk patients after acute myocardial infarction and coronary artery bypass graftsurgery. N Engl J Med 1986;314:161�6.
    Cannon CP, Thompson B, McCabe CH, et al. Predictors of non-Q-wave acute myocardial infarction in patients with acute ischemic syndromes: an analysis from the thrombolysis in myocardial ischemia (TIMI) trials. Am J Cardiol 1995;75:977�81.
    Timmis AD. Probability analysis in the diagnosis of coronary artery disease. BMJ 1985;291:1443�4.
    ISIS-1 Collaborative Group. Randomised trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. Lancet 1986;ii:57�65.
    ISIS-1 Collaborative Group. Mechanisms for the early mortality reduction produced by beta-blockade started early in acute myocardial infarction: ISIS-1. Lancet 1988;i:921�3.
    Pfeffer MA, Braunwald E, Moye LA, et al,  on behalf of the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. N Engl J Med 1992;327:669�77.
    Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342:821�8.
    CIBIS-II Investigators and Committees. The cardiac insufficiency bisoprolol study ii (CIBIS-II): a randomised trial. Lancet 1999;353:9�13.
    Holmes DR Jr, Bates ER, Kleiman NS, et al. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. J Am Coll Cardiol 1995;26:668�74.
    Hochman JS, Sleeper LA, Webb JG, et al, for the SHOCK Investigators. Early revascularisation in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med 1999;341:625�34.
    FRagmin and Fast Revascularisation during InStability in Coronary artery disease (FRISCII) Investigators. Invasive compared with non-invasive treatment in unstable coronary artery disease:FRISC II prospective randomised multicentre study. Lancet 1999;354:708�15.
    Laji K, Wilkinson P, Ranjadayalan K, et al. Prognosis in acute myocardial infarction: comparison of patients with diagnostic and nondiagnostic electrocardiograms. Am Heart J 1995;130:705�10.
    Braunwald E. Unstable angina: a classification. Circulation 1989;80:410�14.
    Clemmensen P, Ohman EM, Sevilla DC, et al. Changes in standard electrocardiographic ST-segment elevation predictive of successful reperfusion in acute myocardial infarction. Am J Cardiol 1990;66:1407�11.
    Schroder R, Dissmann R, Bruggemann T, et al. Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction. J Am Coll Cardiol 1994;24:384�91.
    Hogg KJ, Hornung RS, Howie CA, et al. Electrocardiographic prediction of coronary artery patency after thrombolytic treatment in acute myocardial infarction: use of ST segment as a noninvasive marker. Br Heart J 1988;60:275�80.
    GUSTO Angiographic Investigators. The effects of tissue plasminogen activator, streptokinase or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. N Engl J Med 1993;329:1615�22.
    TIMI Study Group. The thrombolysis in myocardial infarction trial. Phase 1 findings. N Engl J Med 1985;312:932�6.
    Ellis SG, da Silva ER, Heyndrickx G, et al. Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction. Circulation 1994;90:2280�4.
    Archbold RA, Sayer JW, Suliman A, et al. Frequency and prognostic implications of conduction defects in acute myocardial infarction since the introduction of thrombolytic therapy. Eur Heart J 1998;19:893�8.
    Bigger JT Jr, Fleiss JL, Kleiger R, et al. The relationship among ventricular arrhythmias, left ventricular dysfunction, and mortality in the two years after myocardial infarction. Circulation 1984;69:250�8.
    Jacoby RM, Nesto RW. Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol 1992;20:736�44.
    Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol 1995;26:57�65.
    The 4S Study Group. Randomised trial of cholesterol in 4444 patients with coronary heart disease: the Scandinavian simvastatin study. Lancet 1994;344:1382�9.
    Sacks F, Pfeffer M, Moye L, et al. The effects of pravastatin on coronary events after myocardial infarction in patients with average cholesterol. N Engl J Med 1996;335:l00l-9.
    Wood D, Durrington P, McInnes G, et al, for British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, endorsed by British Diabetic Association. Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998;80(suppl 2):S6�12.
    Ravkilde J, Nissen H, Horder M, et al. Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chain levels in suspected acute myocardial infarction. J Am Coll Cardiol 1995;25:574�81.
    Holmvang L, Luscher MS, Clemmensen P, et al, and the TRIM Study Group. Very early risk stratification using combined ECG and biochemical assessment in patients with unstable coronary artery disease. Circulation 1998;98:2004�9.
    Woo J, Lacbawan F, Sunheimer R, et al. Is myoglobin useful in the diagnosis of acute myocardial infarction in the emergency department setting. Am J Clin Pathol 1995;103:725�9.
    Mair J, Artner-Dworzak E, Lechleitner, et al. Cardiac troponin T in diagnosis of acute myocardial infarction. Clin Chem 1991;37:845�52.
    Adams JE, Bodor GS, Davila-Roman VG, et al. Cardiac troponin I: a marker with high specificity for cardiac injury. Circulation 1993;88:101�6.
    Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac specific troponin I levels predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996;335:1342�9.
    Newby LK, Christenson RH, Ohman EM, et al. Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes. The GUSTO-IIa investigators. Circulation 1998;98:1853�9.
    Stubbs P, Collinson P, Moseley D, et al. Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. Circulation 1996;94:1291�7.
    CAPTURE Study Investigators. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med 1999;340:1623�9.
    Multicenter Post-Infarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med 1983;309;321�6.
    Sanz G, Castaner A, Betriu A, et al. Determinants of prognosis in survivors of myocardial infarction: a prospective clinical angiographic study. N Engl J Med 1982;306:1065�70.
    Greenberg H, McMaster P, Dwyer EM Jr. Left ventricular dysfunction after acute myocardial infarction: results of a prospective multicenter study. J Am Coll Cardiol 1984;4:867�74.
    Holmes DR Jr, Davis KB, Mock MB, et al. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the coronary artery surgery study. Circulation 1986;73:1254�63.
    Stevenson R, Umachandran V, Ranjadayalan K, et al. Reassessment of treadmill stress testing for risk stratification in patients with acute myocardial infarction treated by thrombolysis. Br Heart J 1993;70:415�20.
    Wilcox I, Freedman SB, Allman KC, et al. Prognostic significance of a predischarge exercise test in risk stratification after unstable angina pectoris. J Am Coll Cardiol 1991;18:677�83.
    Gill JB, Cairns JA, Roberts RS, et al. Prognostic importance of myocardial ischemia detected by ambulatory monitoring early after acute myocardial infarction. N Engl J Med 1996;334:65�70.
    McComb JM, Gold HK, Leinbach RC, et al. Electrically induced ventricular arrhythmias in acute myocardial infarction treated with thrombolytic agents. Am J Cardiol 1988;62:186�91.
    Willems AR, Tijssen JG, van Capelle FJ, et al. Determinants of prognosis in symptomatic ventricular tachycardia or ventricular fibrillation late after myocardial infarction. The Dutch ventricular tachycardia study group of the Interuniversity Cardiology Institute of The Netherlands. J Am Coll Cardiol 1990;16:521�30.
    Pedretti R, Etro MD, Laporta A, et al. Prediction of late arrhythmic events after acute myocardial infarction from combined use of noninvasive prognostic variables and inducibility of sustained monomorphic ventricular tachycardia. Am J Cardiol 1993;71:1131�41.
    Bigger JT Jr, Fleiss JL, Rolnitzky LM. Prevalence, characteristics and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction. Am J Cardiol 1986;58:1151�60.
    Yusuf S, Lessem J, Jha P, et al. Primary and secondary prevention of myocardial infarction and strokes: an update of randomly allocated controlled trials. J Hypertens 1993;11(suppl 4):S61�73.
    Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982;247:1707�14.
    Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The cardiac arrhythmia suppression trial. N Engl J Med 1991;324:781�8.
    Waldo AL, Camm AJ, deRuyter H, et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD investigators: survival with oral d-sotalol. Lancet 1996;348:7�12.
    Breithardt G, Borggrefe M, Quantius B, et al. Ventricular vulnerability assessed by programmed ventricular stimulation in patients with and without late potentials. Circulation 1983;68:275�81.
    Breithardt G, Borggrefe M, Haerten K. Ventricular late potentials and inducible ventricular tachyarrhythmias as a marker for ventricular tachycardia after myocardial infarction. Eur Heart J 1986;7:127�34.
    Nalos PC, Gang ES, Mandel WJ, et al. The signal-averaged electrocardiogram as a screening test for inducibility of sustained ventricular tachycardia in high risk patients: a prospective study. J Am Coll Cardiol 1987;9:539�48.
    Greenspan AM. Can electrophysiologic testing predict mortality after myocardial infarction? J Am Coll Cardiol 1986;7:124�34.
    Santarelli P, Bellocci F, Loperfido F, et al. Identification of patients at risk of sudden death after myocardial infarction: is there a role for programmed ventricular stimulation? Clin Prog Electrophysiol Pacing 1985;3:115�23.
    Appel ML, Berger RD, Saul JP, et al. Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol 1989;14:1139�48.
    Vaishnav S, Stevenson R, Marchant B, et al. The relation between heart rate variability early after acute myocardial infarction and long-term mortality. Am J Cardiol 1994;73:653�7.
    Kuchar DL, Thorburn CW, Sammel NL. Late potentials detected after myocardial infarction: natural history and prognostic significance. Circulation 1986;74:1280�9.
    Seino Y, Tomita Y, Takano T, et al. Early identification of cardiac events with serum troponin T in patients with unstable angina. Lancet 1993;342:1236�7.

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