Acute Coronary Syndrome (ACS) - Risk Score Tools

From Guide to YKHC Medical Practices



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