Early management of unstable angina and non-ST-segment elevation myocardial infarction: summary of NICE guidance

[...]with a well-validated risk scoring system (GRACE) that uses multiple risk components to predict mortality, a significant number of troponin-positive patients were found to be at low risk, and conversely, some troponin-negative patients were at high risk. 2 The guideline development group (GDG) therefore recommended the use of a validated risk scoring system (such as GRACE (Global Registry of Acute Cardiac Events)) to determine risk in individual patients ( Box 2 ). The GRACE score is derived from a large cohort of unselected patients with ACS, it is available online ( http://www.outcomes-umassmed.org/grace/ , accessed August 2010), is easy to use and its components are an effective tool in an unselected UK population. 5 Box 1 Factors predicting adverse outcome in unstable angina/non-ST elevation myocardial infarction Advancing age Presence and severity of ECG changes of ischaemia Magnitude of rise in biomarkers of myocardial injury (eg, serum troponin) Left ventricular dysfunction Cardiogenic shock Increased heart rate Arrhythmias (ventricular, atrial fibrillation) Renal impairment Diabetes mellitus Anaemia Cerebrovascular disease Peripheral vascular disease Box 2 Global Registry of Cardiac Events (GRACE) risk score for in-hospital death with range of scores for each parameter in parentheses Age (0-100) Killip class (see below) (0-59) Heart rate (0-46) Systolic blood pressure (58-0) Serum creatinine (1-28) ST-segment deviation (28) Cardiac arrest at admission (39) Elevated serum cardiac enzymes (14) Total possible score =372 points GRACE risk score for death at 6 months with range of scores for each parameter in parentheses Age (0-100) Killip class (0-44) Heart rate (0-34) SBP (40-0) Serum creatinine (1-28) ST-segment deviation (17) Cardiac arrest at admission (30) Elevated serum cardiac enzymes (13) Total possible score =306 points NB: