Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto M5B 1W8,Ontario, Canada.
School of Medicine, Faculty of Medicine and Health, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Eur Heart J Qual Care Clin Outcomes. 2021 May 3;7(3):222-228. doi: 10.1093/ehjqcco/qcab018.
Patients with acute coronary syndromes (ACS), particularly non-ST-segment elevation ACS, represent a spectrum of patients at variable risk of short- and long-term adverse clinical outcomes. Accurate prognostic assessment in this population requires the simultaneous consideration of multiple clinical and laboratory variables which may be under-recognized by the treating physicians, leading to an observed risk-treatment paradox in the use of invasive and pharmacological therapies. The routine application of established clinical risk scores, such as the Global Registry of Acute Coronary Events risk score, is recommended by major international clinical practice guidelines for structured risk stratification at the time of presentation, but uptake remains inconsistent. This article discusses the methodology of designing, deriving, and validating clinical risk scores, reviews the major validated risk scores for assessing prognosis in ACS, and examines their role in guiding clinical decision-making in ACS management, especially the timing of invasive coronary angiography. We also discuss emerging data on the impact of the routine use of such risk scores on patient management and clinical outcomes, as well as future directions for investigation in this field.
急性冠状动脉综合征（ACS）患者，尤其是非 ST 段抬高 ACS 患者，代表了一组具有不同短期和长期不良临床结局风险的患者。对该人群进行准确的预后评估需要同时考虑多种临床和实验室变量，而这些变量可能被治疗医生所忽视，导致在使用侵入性和药物治疗方面出现观察到的风险-治疗悖论。主要的国际临床实践指南建议在就诊时使用既定的临床风险评分，如全球急性冠状动脉事件注册风险评分，对风险进行结构化分层，但采用率仍不一致。本文讨论了设计、推导和验证临床风险评分的方法，回顾了评估 ACS 预后的主要验证风险评分，并探讨了它们在指导 ACS 管理中临床决策制定，特别是侵入性冠状动脉造影时机方面的作用。我们还讨论了有关常规使用此类风险评分对患者管理和临床结局的影响的新数据，以及该领域未来的研究方向。
