Clinical risk prediction models for the prognosis and management of acute coronary syndromes
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Published on: January 28, 2020
Hourmazd Haghbayan1, Chris P Gale2, Derek P Chew3
1Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto M5B 1W8,Ontario, Canada.
Insights
Accurate risk assessment in acute coronary syndromes (ACS) is crucial for optimal treatment. This review covers designing, validating, and applying clinical risk scores to improve patient outcomes and guide management decisions.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Health Outcomes Research
Background:
- Patients with acute coronary syndromes (ACS), especially non-ST-segment elevation ACS, have variable risks for adverse outcomes.
- Under-recognition of prognostic variables can lead to a risk-treatment paradox in therapy selection.
- Clinical risk scores are recommended for structured risk stratification but have inconsistent uptake.
Purpose of the Study:
- To discuss the methodology of clinical risk score development and validation.
- To review major validated risk scores for ACS prognosis.
- To examine the role of risk scores in guiding ACS management and invasive strategies.
Main Methods:
- Review of methodology for designing, deriving, and validating clinical risk scores.
- Analysis of major validated risk scores for acute coronary syndromes.
- Examination of the impact of risk scores on clinical decision-making and patient outcomes.
Main Results:
- Discusses the design, derivation, and validation processes for clinical risk scores.
- Reviews key validated risk scores for assessing prognosis in ACS patients.
- Explores the role of these scores in guiding management, including invasive angiography timing.
Conclusions:
- Routine application of validated clinical risk scores is essential for structured risk stratification in ACS.
- Risk scores aid in overcoming the risk-treatment paradox and optimizing patient management.
- Further investigation into the impact of routine risk score use on patient outcomes is warranted.
Abstract:
Patients with acute coronary syndromes (ACS), particularly non-ST-segment elevation ACS, represent a spectrum of patients at variable risk of short- and long-term adverse clinical outcomes. Accurate prognostic assessment in this population requires the simultaneous consideration of multiple clinical and laboratory variables which may be under-recognized by the treating physicians, leading to an observed risk-treatment paradox in the use of invasive and pharmacological therapies. The routine application of established clinical risk scores, such as the Global Registry of Acute Coronary Events risk score, is recommended by major international clinical practice guidelines for structured risk stratification at the time of presentation, but uptake remains inconsistent. This article discusses the methodology of designing, deriving, and validating clinical risk scores, reviews the major validated risk scores for assessing prognosis in ACS, and examines their role in guiding clinical decision-making in ACS management, especially the timing of invasive coronary angiography. We also discuss emerging data on the impact of the routine use of such risk scores on patient management and clinical outcomes, as well as future directions for investigation in this field.
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