Risk Stratification in Acute Coronary Syndromes

Physicians’ estimates of patient risk do guide their treatment decisions but are often inaccurate when compared with validated risk scores.

The “treatment-risk paradox” — wherein higher-risk patients are less likely than lower-risk patients to receive evidence-based therapies — has been demonstrated in the care of patients with acute coronary syndromes in several studies (JW Cardiol Jun 13 2007). The reasons for this pattern of care have not been identified. Using data from a Canadian registry of 1956 patients with ACS, investigators compared treating physicians’ estimates of patients’ risk for death with predicted risks as scored by three validated instruments (TIMI, GRACE, and PURSUIT).

The physicians categorized 17.8% of the patients as low risk, 42.0% as intermediate risk, and 40.2% as high risk. When stratified by these physician-assigned categories, higher-risk patients we…

Reviewing Author

Frederick A. Masoudi, MD, MSPH

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)