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Lookup NU author(s): Dr Ravikumar Balasubramanian, Dr Chris WilkinsonORCiD, Professor Vijay KunadianORCiD
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© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.We summarise the international guidelines surrounding risk stratification as well as discuss new emerging data for future development of a new risk model in the management of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS accounts for the bulk of acute coronary syndrome presentations in the UK, but management strategies in this group of patients have remained a subject of debate for decades. Patients with NSTE-ACS represent a heterogeneous population with a wide variation in short-term and long-term clinical outcomes, which makes a uniform, standardised treatment approach ineffective and inappropriate. Studies in the modern era have provided some guidance in treating this subset of patients: the provision of early, more potent therapies has been shown to improve outcomes in patients at a particularly elevated risk of adverse outcomes. International guidelines recommend adopting an individualised treatment approach through the use of validated risk prediction models to identify such patients at high risk of adverse outcomes. The present available evidence, however, is based on dated demographics, different diagnostic thresholds and outdated therapies. In particular, the evidence has limited applicability to female patients and older people with frailty. Moreover, the current risk models do not capture key prognostic variables, leading to an inaccurate estimation of patients' baseline risk and subsequent mistreatment. Therefore, the current risk models are no longer fit for purpose and there is a need for risk prediction scores that account for different population demographics, higher sensitivity troponin assays and contemporary treatment options.
Author(s): Balasubramanian RN, Mills GB, Wilkinson C, Mehran R, Kunadian V
Publication type: Review
Publication status: Published
Journal: Heart
Year: 2023
Volume: 109
Issue: 7
Pages: 504-510
Online publication date: 14/09/2022
Acceptance date: 24/08/2022
ISSN (print): 1355-6037
ISSN (electronic): 1468-201X
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/heartjnl-2022-321470
DOI: 10.1136/heartjnl-2022-321470
PubMed id: 36104217
