What is the role of risk assessments in the evaluation of acute coronary syndrome (ACS) symptoms?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Several risk assessment scores and clinical prediction algorithms are used to help identify patients with ACS at increased risk of adverse outcomes, such as TIMI (Thrombolysis In Myocardial Infarction) risk score, the GRACE (Global Registry of Acute Coronary Events) risk score, and the NCDR-ACTION (National Cardiovascular Data Registry-Acute Coronary Treatment and Intervention Outcomes Network) registry. [1, 3]

Investigators have also proposed a novel risk scoring system that may have the potential to predict cardiovascular death in patients with acute MI; the CHA2DS2-VASc-CF takes into account cigarette smoking and a family history of coronary artery disease as risk factors. [46]  In a retrospective study (2009-2016) comprising 4373 patients with acute MI (STEMI: n = 1427; NSTEMI: n = 2946) who presented to an emergency department and underwent cardiac catherization proceures, patients who experienced cardiac death in the follow-up period had significantly higher CHA2DS2-VASc and CHA2DS2-VASc-CF scores, and were more likely to have had major adverse cardiac events and hypertension, were older and current smokers, and have a family history of coronary artery disease; this group also had a significantly lower left ventricular ejection fraction and glomerular filtration rate than those who did not experience cardiovascular death. When the cutoff score for the CHA2DS2-VASc-CF was defined as greater than 3, there was a 78.4% sensitivity and 76.4% specificity for predicting long-term cardiovascular death. [46]

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