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Risk stratification after non-ST elevation acute coronary syndrome

Michael Simons, MD
Joseph S Alpert, MD
Pamela S Douglas, MD
Peter WF Wilson, MD
Jeffrey A Breall, MD, PhD
Section Editors
Christopher P Cannon, MD
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Allan S Jaffe, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Gordon M Saperia, MD, FACC


All patients with non-ST elevation acute coronary syndromes (NSTEACS), which includes unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI), should undergo early and late risk stratification. This process impacts decision making regarding treatment and provides the patient with some sense of what the future holds.  

The general approach to risk stratification for patients with UA/NSTEMI will be reviewed here. Risk stratification is accomplished with the use of validated risk prediction models that include the most important predictors of outcome. These individual predictors are discussed separately. (See "Risk factors for adverse outcomes after non-ST elevation acute coronary syndromes".)

Risk stratification for patients with an acute ST elevation MI (STEMI) and for those at risk for life-threatening arrhythmias is discussed separately. (See "Risk stratification after acute ST-elevation myocardial infarction" and "Incidence of and risk stratification for sudden cardiac death after acute myocardial infarction".)


Individuals with any one of the following clinical characteristics are deemed to be at such high risk that formal early risk stratification is not necessary. These patients typically need to proceed to urgent coronary angiography:

Cardiogenic shock

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Literature review current through: Nov 2017. | This topic last updated: Mar 08, 2017.
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