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Risk stratification after acute ST-elevation myocardial infarction

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

INTRODUCTION

All patients with ST-elevation myocardial infarction (STEMI) should undergo early and late risk stratification soon after presentation. Since most patients with STEMI undergo reperfusion therapy, early risk stratification provides the patient and family with some sense of what the future holds. Late risk stratification attempts to identify patients who are at increased risk for late arrhythmic or nonarrhythmic death.

The general approach to risk stratification for patients with STEMI 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 ST-elevation myocardial infarction".) Risk stratification for patients with acute non-ST elevation acute coronary syndromes and for those at risk for life-threatening arrhythmias is discussed separately. (See "Risk stratification after non-ST elevation acute coronary syndrome" and "Incidence of and risk stratification for sudden cardiac death after acute myocardial infarction".)

EARLY RISK STRATIFICATION

All patients with ST-elevation myocardial infarction (STEMI) should undergo risk assessment with one of the tools presented below within the first four to six hours of hospitalization. However, even low-risk patients should undergo primary reperfusion (usually with percutaneous coronary intervention) in a timely manner. (See "Acute ST elevation myocardial infarction: Selecting a reperfusion strategy", section on 'Summary and recommendations'.)

We prefer the TIMI risk score or the GRACE risk model. These tools include predictors of poor outcomes identified in large databases of patients with STEMI. (See "Risk factors for adverse outcomes after ST-elevation myocardial infarction".)

A report published in 1998 from the National Registry of Myocardial Infarction (NRMI) evaluated data on 170,143 patients admitted with an acute myocardial infarction (MI) (with or without ST segment elevation) in an attempt to identify patients at high risk [1]. Significant risk factors included age over 70 years, prior MI, Killip class at admission (table 1), anterior MI, and the combination of hypotension and tachycardia.

                  

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 15 00:00:00 GMT+00:00 2015.
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