Acute Coronary Syndrome (ACS) - Risk Score Tools

DIAGNOSTIC TOOLS

Sgarbossa's Criteria (MD-Calc)

Criteria to diagnose acute MI in patients with prior LBBB.

It's often difficult to identify an MI for patients with existing left bundle branch blocks (LBBB). About 1 in 200 patients with MI have LBBB. Sgarbossa's is a well accepted approach at determining which LBBB are having an MI.

HE-MACS (MD-Calc) (History and Electrocardiogram-only Manchester Acute Coronary Syndromes)

Stratifies ACS risk with history and EKG only (not yet externally validated).

INSTRUCTIONS: Use in patients ≥18 years old presenting with suspected cardiac chest pain (symptoms within the last 24 hours).

T-MACS (MD-Calc) (Troponin-only Manchester Acute Coronary Syndromes Decision Aid)

Rules out acute coronary syndrome.

WHEN TO USE: Patients with chest pain that may be cardiac in nature.

ADD-RS (Aortic Dissection Detection Risk Score)

Rules out aortic dissection

IMPORTANT: ADD-RS + D-dimer (the ADvISED study algorithm) has not been externally validated in ruling out acute aortic dissection and should thus be used with caution. The ADD-RS itself is validated.

PROGNOSTIC TOOLS

TIMI Risk Index (MD-Calc)

Provides mortality estimate in patients with ACS using only blood pressure, heart rate, and age.

A simple calculator to predict 30-day mortality, which has been well validated against a registry of 150,000 STEMI patients, and shown to have a very good discriminatory capacity. It was also validated against a registry of over 300,000 NSTEMI patients. It has been shown to both predict in-hospital and long-term mortality.

TIMI Risk Score for UA/NSTEMI (MD-Calc)

Estimates mortality for patients with unstable angina and non-ST elevation MI.

Can be used to help risk stratify patients with presumed ischemic chest pain. However, it was originally derived in patients with confirmed unstable angina or non-ST elevation myocardial infarction.

HEART Score for Major Cardiac Events (MD-Calc)

Predicts 6-week risk of major adverse cardiac event.

INSTRUCTIONS: Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission.

Killip Classification for Heart Failure (MD-Calc)

Quantifies severity of heart failure in ACS and predicts 30-day mortality.

WHEN TO USE: Patients with confirmed acute coronary syndrome.

Acute Coronary Syndrome Wiki Supplement Page