title: Risk determination after an acute myocardial infarction: review of 3 clinical risk prediction tools.
abstract: OBJECTIVE
  The objective of the study was to provide comprehensive information for the clinical nurse specialist (CNS) on commonly used clinical prediction (risk assessment) tools used to estimate risk of a secondary cardiac or noncardiac event and mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  The evolution and widespread adoption of primary PCI represent major advances in the treatment of acute myocardial infarction, specifically STEMI. The American College of Cardiology and the American Heart Association have recommended early risk stratification for patients presenting with acute coronary syndromes using several clinical risk scores to identify patients' mortality and secondary event risk after PCI. Clinical nurse specialists are integral to any performance improvement strategy. Their knowledge and understandings of clinical prediction tools will be essential in carrying out important assessment, identifying and managing risk in patients who have sustained a STEMI, and enhancing discharge education including counseling on medications and lifestyle changes.
  
  
  METHODS
  Over the past 2 decades, risk scores have been developed from clinical trials to facilitate risk assessment. There are several risk scores that can be used to determine in-hospital and short-term survival. This article critiques the most common tools: the Thrombolytic in Myocardial Infarction risk score, the Global Registry of Acute Coronary Events risk score, and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications risk score.
  
  
  RESULTS
  The importance of incorporating risk screening assessment tools (that are important for clinical prediction models) to guide therapeutic management of patients cannot be underestimated. The ability to forecast secondary risk after a STEMI will assist in determining which patients would require the most aggressive level of treatment and monitoring postintervention including outpatient monitoring. With an increased awareness of specialist assessment tools, the CNS can play an important role in risk prevention and ongoing cardiovascular health promotion in patients diagnosed with STEMI.
  
  
  CONCLUSIONS
  Knowledge of clinical prediction tools to estimate risk for mortality and risk of secondary events after PCI for acute coronary syndromes including STEMI is essential for the CNS in assisting with improving short- and long-term outcomes and for performance improvement strategies. The risk score assessment utilizing a collaborative approach with the multidisciplinary healthcare team provides for the development of a treatment plan including any invasive intervention strategy for the patient.
authors.affiliation: St Vincent's/ACU National Center for Nursing Research, School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia. Elizabeth.Scruth@kp.org
authors.forename: Elizabeth Ann
authors.initials: EA
authors.lastname: Scruth
authors.forename: Karen
authors.initials: K
authors.lastname: Page
authors.forename: Eugene
authors.initials: E
authors.lastname: Cheng
authors.forename: Michelle
authors.initials: M
authors.lastname: Campbell
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D009720:Nurse Clinicians / Q000193:education*; D009730:Nursing Assessment / Q000379:methods*; D015404:Nursing Methodology Research; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome