Risk stratification in acute coronary syndromes: Graced by a new score?
نویسندگان
چکیده
We read with much interest the recently published paper by Timóteo et al.1 This study makes an important contribution to the expanding field of risk stratification in myocardial infarction (MI), which is the cornerstone for patient management. The authors developed a simple risk model from a large cohort of real-world MI patients, comprising common and easily accessible clinical variables, constructing a high-performing in-hospital mortality risk score. Several risk scores have been developed to predict outcomes in patients with acute coronary syndromes. The GRACE score2 is the most widely used and has been shown to outperform other previously developed mortality risk models.3 The ACHTUNG-Rule,4 based on clinical and laboratory parameters, outperformed the GRACE score in its derivation and validation sets but, in addition to requiring a calculator, it still lacks calibration and validation in larger and external cohorts. McNamara et al.5 recently developed a novel in-hospital mortality risk score from a large contemporary cohort, with calibration curves demonstrating its utility even in patients presenting with cardiac arrest, a significant advantage in the context of MI given the difficulty in accurately predicting outcomes in this patient subgroup. Although the GRACE and ProACS1 scores share some variables, the latter does have some advantages: (i) it is simpler to use in clinical practice, with fewer variables and no need for a calculator; (ii) it uses the same cutoffs for ST-elevation (STEMI) and non-ST-elevation (NSTEMI) MI, unlike GRACE; and (iii) it is particularly useful in identifying truly low-risk patients, as a score of 0 is associated with very low risk of in-hospital mortality (0.4%). In contrast, the GRACE score predicts mortality risk as a continuum, although low-risk strata have been proposed for STEMI and NSTEMI cases.
منابع مشابه
Response to Letter to the Editor "Risk stratification in acute coronary syndromes: Graced by a new score?"
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ورودعنوان ژورنال:
- Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
دوره 36 9 شماره
صفحات -
تاریخ انتشار 2017