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(Circulation. 2002;106:1588.)
© 2002 American Heart Association, Inc.

Editorial

Evidence-Based Risk Stratification to Target Therapies in Acute Coronary Syndromes

Christopher P. Cannon, MD

From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.

Correspondence to Christopher Cannon, MD, TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail cpcannon@partners.org

Key Words: Editorials • angina • myocardial infarction • catheterization • anticoagulants

An extract of the first 250 words of the full text is provided, because this article has no abstract.

With the ever-increasing number of new treatments for the wide spectrum of patients with acute coronary syndromes (ACS), risk stratification has become the centerpiece of initial evaluation for these patients.¹ The overriding principle is to target more aggressive antithrombotic and interventional therapies in patients at higher risk.^1,2

See p 1622

The approach to risk stratification has evolved during the past 2 decades from a practice that once involved an evaluation for residual ischemia and for left ventricular dysfunction after myocardial infarction (MI). However, risk stratification has now evolved more to include assessment of the risk of future cardiac events, which can be predicted on the basis of clinical features at the time of the initial assessment in the emergency department. This change in timing parallels the change in nomenclature of ACS from Q-wave/non–Q wave MI to ST-elevation MI (STEMI) versus non-STEMI, a change that was made necessary by the need to make immediate treatment decisions about reperfusion therapy for those with ST elevation (and not for those without ST elevation).² Similarly, risk stratification is now performed immediately (not days later) to assist in decisions on appropriate initial therapy and triage.

This notion of immediate risk assessment was first proposed in the 1994 unstable angina guidelines,³ and is now strongly evidence based, with numerous studies supporting the need to target the newer antithrombotic and interventional therapies to higher-risk ACS patients.^4–18 Thus, risk stratification is key to the initial evaluation of patients with ACS because physicians will treat patients differently on the . . . [Full Text of this Article]

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