The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients.
OBJECTIVE
To review the methods available for the risk stratification of non-ST elevation (NSTE) acute coronary syndrome (ACS) patients and to evaluate the use of risk scores for their initial risk assessment.


METHODS
The data of the present review were identified by searching PUBMED and other databases (1996 to 2008) using the key terms "risk stratification", "risk scores", "NSTEMI", "UA" and "acute coronary syndrome".


METHODS
Mainly original articles, guidelines and critical reviews written by major pioneer researchers in this field were selected.


RESULTS
After evaluation of several risk predictors and risk scores, it was found that estimating risk based on clinical characteristics is challenging and imprecise. Risk predictors, whether used alone or in simple binary combination, lacked sufficient precision because they have high specificity but low sensitivity. Risk scores are more accurate at stratifying NSTE ACS patients into low-, intermediate- or high-risk groups. The Global Registry of Acute Cardiac Events risk score was found to have superior predictive accuracy compared with other risk scores in ACS population. Treatments based according to specific clinical and risk grouping show that certain benefits may be predominantly or exclusively restricted to higher risk patients.


CONCLUSIONS
Based on the trials in the literature, the Global Registry of Acute Cardiac Events risk score is more advantageous and easier to use than other risk scores. It can categorize a patient's risk of death and/or ischemic events, which can help tailor therapy to match the intensity of the patient's NSTE ACS.
Khalill
Ramjane
R
Cardiology Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Han
Lei
L
Jing
Chang
C
Quan
He
H
Lancet. 1997 May 3;349(9061):1269-76
9142060
Acad Emerg Med. 2002 Mar;9(3):203-8
11874776
JAMA. 2000 Oct 11;284(14):1799-805
11025832
Circulation. 2002 Oct 29;106(18):2292-3
12403653
N Engl J Med. 2005 Nov 3;353(18):1889-98
16267320
Br J Gen Pract. 1999 Jul;49(444):551-4
10621990
Arch Intern Med. 1998 Nov 23;158(21):2329-38
9827784
Heart. 2003 Sep;89(9):1003-8
12923009
N Engl J Med. 2004 Sep 23;351(13):1285-95
15385655
Nephrol Dial Transplant. 2005 Oct;20(10):2105-12
16030030
Eur Heart J. 2005 May;26(9):865-72
15764619
JAMA. 2004 Jun 9;291(22):2727-33
15187054
JAMA. 1995 Jan 11;273(2):136-41
7799494
BMJ. 2002 Jul 20;325(7356):116-7
12130592
Circulation. 2002 Oct 29;106(18):2309-14
12403659
Lancet. 2003 Jan 4;361(9351):13-20
12517460
Circulation. 2004 Feb 3;109(4):494-9
14744970
N Engl J Med. 2001 Jun 21;344(25):1879-87
11419424
JAMA. 2003 Oct 22;290(16):2174-81
14570953
Am Heart J. 2001 Feb;141(2):190-9
11174331
Circulation. 2002 Aug 20;106(8):974-80
12186803
JAMA. 1999 Feb 24;281(8):707-13
10052440
Am Heart J. 1989 Mar;117(3):657-65
2784024
QJM. 2003 Dec;96(12):893-8
14631055
Eur Heart J. 2007 Jul;28(13):1598-660
17569677
Am J Cardiol. 1987 Oct 1;60(10):766-70
3661390
Eur Heart J. 2003 Jan;24(1):28-66
12559937
Circulation. 2000 Jun 6;101(22):2557-67
10840005
JAMA. 2000 Aug 16;284(7):835-42
10938172
Am J Cardiol. 2005 Oct 1;96(7):913-6
16188515
Am Heart J. 2004 Dec;148(6):1020-7
15632888
Arch Intern Med. 2003 Oct 27;163(19):2345-53
14581255
Prog Cardiovasc Dis. 2004 Nov-Dec;47(3):177-88
15736583
Am J Cardiol. 2001 Oct 15;88(8):848-52
11676945
Ann Intern Med. 2002 Jan 15;136(2):161-72
11790072
Heart. 2004 Jun;90(6):603-9
15145852
Lancet. 2005 Sep 10-16;366(9489):914-20
16154018
BMJ. 2000 Jun 24;320(7251):1702-5
10864545
Circulation. 2008 Dec 16;118(25):2803-10
19064680
Am J Cardiol. 2002 Aug 1;90(3):303-5
12127617
Am J Cardiol. 2003 Apr 15;91(8):968-71, A4
12686338
Am Heart J. 1999 Dec;138(6 Pt 1):1046-57
10577434
Circulation. 1999 Aug 10;100(6):599-607
10441096
Heart. 2005 Mar;91(3):290-8
15710703
J Am Coll Cardiol. 2003 Nov 5;42(9):1535-43
14607434
J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157
17692738
Circulation. 2005 Apr 5;111(13):1611-8
15811868
Am J Cardiol. 2004 Apr 1;93(7):916-9
15050498
BMJ. 2006 Nov 25;333(7578):1091
17032691
J Am Coll Cardiol. 2003 Mar 5;41(5):718-24
12628712
J Am Coll Cardiol. 2004 Aug 4;44(3):E1-E211
15358047
Arch Intern Med. 2008 Feb 11;168(3):291-6
18268170
Eur Heart J. 2002 Feb;23(3):223-9
11792137
Clin Chem. 1999 Jul;45(7):1104-21
10388496
Eur Heart J. 2002 Dec;23(23):1809-40
12503543
Lancet. 1994 Feb 5;343(8893):311-22
7905143
Lancet. 1999 Aug 28;354(9180):708-15
10475181
Heart. 2004 Jun;90(6):698-706
15145891
Eur Heart J. 2004 Nov;25(22):1998-2005
15541835
Am Heart J. 2000 Apr;139(4):649-53
10740147