![]() NSTE-ACS: non-ST-elevation acute coronary syndrome. Abbreviations: ACS: acute coronary syndrome. In all studies, MACE was defined as the composite of death, myocardial infarction or revascularization. All articles used in Table 1 can be found in the Supplementary data. Lowest and highest reported values measured in validation studies are reported of all other risk scores. are used for the validation studies of the history, electrocardiogram, age, risk factors, troponin- (HEART)-score. Results from the systematic review from Laureano et al. Results from the derivation cohorts and validation cohorts are displayed separately. Diagnostic performance results are provided for risk scores only and risk score pathways for major adverse cardiac events (MACE) within 30 days or six weeks. An overview of all risk scores and pathways with their components are found in the Supplementary data (I–III). Using this ACS timeline, the most relevant risk scores used for patients with ACS will be discussed in this review using general performance metrics, model discrimination and calibration, and if available, results of both internal and external validation studies. In the months or years following ACS, risk scores are available to calculate ischemic-bleeding trade-off risk for optimal antithrombotic management or to estimate long term risk for future cardiovascular events. Individual risk of mortality, myocardial infarction (MI) or bleeding may be re-evaluated before hospital discharge to determine the outpatient treatment strategy. At admission, risk scores are used to estimate the in-hospital or short-term risk of mortality and/or bleeding and to guide further in-hospital management (e.g., timing of coronary angiography). At initial presentation, risk scores are used in patients with acute chest pain and possible ACS to, first, identify patients at low risk for major adverse cardiac events (MACE) and second, as a decision rule to swiftly discharge these patients without additional invasive testing. This allows the risk scores to be easily calculated and interpreted, and some risk scores are also used as decision rules to aid physicians in daily clinical practice.Īt different moments in the timeline of ACS, risk scores can be used for risk stratification. Risk models are often developed from predictors identified from large datasets and afterwards are simplified into risk scores, where numerical weights (points) are assigned to each risk factor, which reflects the risk of a certain outcome. Since the widely used Framingham risk score was published as a prediction model for incident cardiovascular disease, numerous risk prediction models used in cardiovascular medicine have been developed over the last few decades. Though no score is perfect, risk scores are still considered as valuable tools in clinical decision-making. Based on clinical parameters, multiple risk scores have been developed to aid physicians in risk stratification in complement to clinical judgement. For every ACS patient, a risk assessment is performed prior to treatment decision-making at different points along the ACS pathway. Acute coronary syndrome (ACS), including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI), is one of the most frequent reasons for cardiac hospital admission.
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