ACS stratification

Question 2

What is the HEART Score?

What are its elements?

Who can it not be used on?

Answer 2

• A tool used to assess patients presenting with symptoms suggestive of ACS for risk at 6wks of Major Adverse Coronary Events (MACE).
• Each category (below) attracts 0-2 points (low - medium - high)
  
  • History
  • ECG
  • Age
  • Risk factors
  • Troponin
    
    • Score 0-3: <1.7%
    • Score 4-6: 12-16%
    • Score 7-9: 50-65%
• Cannot be used in STEMI, hypotension, life expectancy <1yr or other cause for admission.

Question 3

What is the TIMI Score?

What are its elements?

Answer 3

Calculates the risk at 14 days in confirmed ACS patients of MACE.

• One point for each:
  
  • Age >65
  • >= 3 CAD RFs
  • Known CAD (stenosis >=50%)
  • Aspirin use in past 7days
  • Severe angina (>= 2 episodes in 24h)
  • ST changes >= 0.5mm
  • Cardiac enzyme elevation

NB >= 3pts = high risk -> early reperfusion

• Risk increments with each point:
  
  • 0-1pt = 5%
  • 2pt = 8%
  • 3pt = 13%
  • 4pt = 20% and so on…

Question 4

What is the Killip Classification?

What does it predict?

Answer 4

1. No signs of CHF
2. Crackles, S3, raised JVP
3. APO
4. Cardiogenic shock

It predicts 30-day mortality:

1. 3%
2. 9%
3. 15%
4. 81%

NB: the classification was based on a study from 1960’s - mortalities have changed with improved therapies.

Question 5

What is the GRACE Score?

What does it predict?

Answer 5

GRACE - Global Registry of Acute Coronary Events

Components of GRACE Score (each component is weighted by the calculator):

• Age
• Heart rate
• SBP
• Creatinine
• Killip Class (CHF classification system)
• Cardiac arrest at presentation
• ST segment elevation
• Elevated cardiac markers

It estimates the risk of 6mth all-cause mortality.

Question 6

What are the three recommendations of the AHA with regards the mgt of patients with undifferentiated chest pain?

Answer 6

1. All patients should undergo an ECG in the first ten minutes of their presentation
2. All patients should be risk stratified using an evidence-based Suspected ACS protocol
3. All patients should be further stratified using serial troponins in conjunction with the above Suspected ACS protocol.