PMID- 36104217
OWN - NLM
STAT- MEDLINE
DCOM- 20230314
LR  - 20230330
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 109
IP  - 7
DP  - 2023 Mar 10
TI  - Role and relevance of risk stratification models in the modern-day management of 
      non-ST elevation acute coronary syndromes.
PG  - 504-510
LID - 10.1136/heartjnl-2022-321470 [doi]
AB  - 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      thresholds and outdated therapies.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.
CI  - (c) Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Balasubramanian, R Navin
AU  - Balasubramanian RN
AD  - Newcastle University Translational and Clinical Research Institute, Newcastle 
      upon Tyne, UK.
FAU - Mills, Greg B
AU  - Mills GB
AUID- ORCID: 0000-0002-7981-3594
AD  - Newcastle University Translational and Clinical Research Institute, Newcastle 
      upon Tyne, UK.
FAU - Wilkinson, Chris
AU  - Wilkinson C
AUID- ORCID: 0000-0003-0748-0150
AD  - Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
      University, Newcastle upon Tyne, UK.
AD  - Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS 
      Foundation Trust, Newcastle upon Tyne, UK.
FAU - Mehran, Roxana
AU  - Mehran R
AUID- ORCID: 0000-0002-5546-262X
AD  - The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine 
      at Mount Sinai, New York, New York, USA.
FAU - Kunadian, Vijay
AU  - Kunadian V
AUID- ORCID: 0000-0003-2975-6971
AD  - Newcastle University Translational and Clinical Research Institute, Newcastle 
      upon Tyne, UK vijay.kunadian@newcastle.ac.uk.
AD  - Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS 
      Foundation Trust, Newcastle upon Tyne, UK.
LA  - eng
GR  - CS/15/7/31679/BHF_/British Heart Foundation/United Kingdom
GR  - DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20230310
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Troponin)
SB  - IM
MH  - Humans
MH  - Female
MH  - Aged
MH  - *Acute Coronary Syndrome/diagnosis
MH  - Risk Assessment
MH  - Prognosis
MH  - Troponin
OTO - NOTNLM
OT  - Acute Coronary Syndrome
OT  - Atherosclerosis
OT  - Cardiac Catheterization
OT  - Coronary Stenosis
COIS- Competing interests: None declared.
EDAT- 2022/09/15 06:00
MHDA- 2023/03/15 06:00
CRDT- 2022/09/14 21:44
PHST- 2022/06/02 00:00 [received]
PHST- 2022/08/24 00:00 [accepted]
PHST- 2022/09/15 06:00 [pubmed]
PHST- 2023/03/15 06:00 [medline]
PHST- 2022/09/14 21:44 [entrez]
AID - heartjnl-2022-321470 [pii]
AID - 10.1136/heartjnl-2022-321470 [doi]
PST - epublish
SO  - Heart. 2023 Mar 10;109(7):504-510. doi: 10.1136/heartjnl-2022-321470.