A novel algorithm to identify high risk non-ST-elevation acute coronary syndrome patients
Georgios Chalikias1, Dimitrios Stakos1, Anna Dagre2
1Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis.
Insights
The SAVE score effectively identifies patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who have high-risk angiographic features. This score aids in determining which patients may benefit from early invasive strategies, improving NSTE-ACS management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- The optimal timing for invasive coronary angiography in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is debated.
- Current NSTE-ACS management algorithms may not adequately consider angiographic risk and myocardium at risk.
- Noninvasive risk stratification is crucial for guiding early invasive strategies.
Purpose of the Study:
- To evaluate the diagnostic performance of the SAVE score in NSTE-ACS patients.
- To identify patients with high-risk angiographic features noninvasively.
- To determine if the SAVE score can guide early invasive management decisions.
Main Methods:
- Prospective assessment of 950 consecutive NSTE-ACS patients across five hospitals.
- Risk stratification of 598 patients using the SAVE risk score.
- Primary endpoint: identification of high-risk angiographic features.
Main Results:
- High-risk angiographic features were present in 58% of patients.
- SAVE score was significantly higher in the high-risk angiography group (P < 0.001).
- The SAVE score correctly identified high angiographic risk in 79% of patients and low risk in 58%.
Conclusions:
- The SAVE score demonstrates adequate performance in identifying high-risk NSTE-ACS patients.
- This score can assist in selecting patients who may benefit from early invasive management.
- The SAVE score offers a valuable tool for risk stratification in NSTE-ACS.
Background:
Timing of invasive coronary angiography in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains controversial. Angiographic risk and, hence, myocardium at risk are not necessarily considered in currently used non-ST elevation myocardial infarction management algorithms. The aim of this study was to assess the diagnostic performance of the SAVE score in NSTE-ACS patients to noninvasively identify patients with high-risk angiographic risk who might benefit from an early invasive strategy.
Methods:
We prospectively assessed 950 consecutive patients admitted to five different hospitals with a diagnosis of NSTE-ACS, 598 (491 male, mean age 63 ± 12 years) of whom were risk-stratified according to the SAVE risk score. The primary endpoint was the identification of high-risk angiographic features.
Results:
High-risk angiographic features were observed in 347 (58%) (292 male/55 female). SAVE score was significantly higher in patients in the high-risk angiography group compared with patients without high-risk features [6 (4.5-8) ± vs. 4 (2-5.5); P < 0.001]. Using the proposed risk score, 79% (275 out of 347 patients) were correctly identified as having a high angiographic risk, and 58% (145 out of 251 patients with low-risk angiographic features) were also correctly identified by the SAVE score.
Conclusions:
The SAVE score adequately identified patients with high angiographic risk who may benefit from early invasive management strategies.
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