Issues in early risk stratification for UA/NSTEMI
1 Brigham and Women's Hospital, Boston, Massachusetts, USA
2 Catholic University Hospital, Santiago, Chile
3 University of Vienna, Vienna, Austria
4 Mayo Clinic, Rochester, Minnesota, USA
* Correspondence: Elliott M, Antman, Brigham and Women's Hospital, Boston, Massachusetts, USA
Abstract
North American and European task forces representing the ACC/AHA and the ESC have recently developed new treatment guidelines for the management of unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI). At the 4th Annual Experts' Meeting of the International Cardiology Forum, workshops were held to review the new recommendations. In the discussion of risk stratification, the most debated topic was the role assigned to the cardiac-specific troponins (cTnI and cTnT). Although the importance of these indicators in an integrated risk stratification scheme was well accepted, some participants felt that they received undue emphasis in the new guidelines, and the implication that troponin status should determine use of a glycoprotein IIb/IIIa inhibitor and early catheterization was debated. The value of continuous versus serial ECG monitoring was also discussed, but no consensus was reached. Although many were encouraged by the data on C-reactive protein (CRP) as a prognostic indicator, it was generally agreed that it is too soon to recommend its routine measurement in ACS. Finally, risk stratification is a complex, ongoing process that is impossible to reduce to a simple treatment algorithm.
Key Words: Unstable angina • risk stratification • troponins • guidelines
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