array:26 [
  "pii" => "S087025511630378X"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2016.12.001"
  "estado" => "S300"
  "fechaPublicacion" => "2017-02-01"
  "aid" => "929"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2017;36:85-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2288
    "formatos" => array:3 [
      "EPUB" => 177
      "HTML" => 1665
      "PDF" => 446
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204917300284"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2017.02.004"
      "estado" => "S300"
      "fechaPublicacion" => "2017-02-01"
      "aid" => "929"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2017;36:85-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1491
        "formatos" => array:3 [
          "EPUB" => 178
          "HTML" => 1008
          "PDF" => 305
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
        "titulo" => "Risk stratification after acute coronary syndromes&#58; Scores&#44; scores and yet another score"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "85"
            "paginaFinal" => "87"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Estratifica&#231;&#227;o de risco ap&#243;s s&#237;ndromes coron&#225;rias agudas&#46; <span class="elsevierStyleItalic">Scores</span>&#44; <span class="elsevierStyleItalic">scores</span> e mais &#40;um&#41; <span class="elsevierStyleItalic">score</span>"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Daniel Ferreira"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Daniel"
                "apellidos" => "Ferreira"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S087025511630378X"
          "doi" => "10.1016/j.repc.2016.12.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630378X?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300284?idApp=UINPBA00004E"
      "url" => "/21742049/0000003600000002/v1_201702240018/S2174204917300284/v1_201702240018/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255116303791"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.07.008"
    "estado" => "S300"
    "fechaPublicacion" => "2017-02-01"
    "aid" => "930"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2017;36:89-93"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3007
      "formatos" => array:3 [
        "EPUB" => 198
        "HTML" => 2271
        "PDF" => 538
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "89"
          "paginaFinal" => "93"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Compara&#231;&#227;o da presen&#231;a dos complexos QRS fragmentados nas deriva&#231;&#245;es anteriores <span class="elsevierStyleItalic">versus</span> inferiores na predi&#231;&#227;o da severidade da doen&#231;a arterial coron&#225;ria"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 546
              "Ancho" => 960
              "Tamanyo" => 125090
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An example of fragmented QRS in the inferior leads&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mehmet Eyuboglu, Ugur Kucuk, Omer Senarslan, Bahri Akdeniz"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mehmet"
              "apellidos" => "Eyuboglu"
            ]
            1 => array:2 [
              "nombre" => "Ugur"
              "apellidos" => "Kucuk"
            ]
            2 => array:2 [
              "nombre" => "Omer"
              "apellidos" => "Senarslan"
            ]
            3 => array:2 [
              "nombre" => "Bahri"
              "apellidos" => "Akdeniz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917300260"
        "doi" => "10.1016/j.repce.2017.02.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300260?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303791?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000002/v1_201702090011/S0870255116303791/v1_201702090011/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255116303778"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.05.010"
    "estado" => "S300"
    "fechaPublicacion" => "2017-02-01"
    "aid" => "928"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2017;36:77-83"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2731
      "formatos" => array:3 [
        "EPUB" => 189
        "HTML" => 2013
        "PDF" => 529
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "ProACS risk score&#58; An early and simple score for risk stratification of patients with acute coronary syndromes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "77"
          "paginaFinal" => "83"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "<span class="elsevierStyleItalic">Score</span> de risco ProACS&#58; em <span class="elsevierStyleItalic">score</span> simples e precoce para estratifica&#231;&#227;o de risco em doentes com s&#237;ndromes coron&#225;rias agudas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1270
              "Ancho" => 1608
              "Tamanyo" => 74518
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Fit of the final multivariate logistic regression model in the development cohort&#46; df&#58; degrees of freedom&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Teresa Tim&#243;teo, S&#237;lvia Aguiar Rosa, Marta Afonso Nogueira, Adriana Belo, Rui Cruz Ferreira"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Ana Teresa"
              "apellidos" => "Tim&#243;teo"
            ]
            1 => array:2 [
              "nombre" => "S&#237;lvia"
              "apellidos" => "Aguiar Rosa"
            ]
            2 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Afonso Nogueira"
            ]
            3 => array:2 [
              "nombre" => "Adriana"
              "apellidos" => "Belo"
            ]
            4 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Cruz Ferreira"
            ]
            5 => array:1 [
              "colaborador" => "on behalf of the ProACS Investigators"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917300259"
        "doi" => "10.1016/j.repce.2017.02.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300259?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303778?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000002/v1_201702090011/S0870255116303778/v1_201702090011/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "pii" => "S0870255116303778"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2016.05.010"
      "estado" => "S300"
      "fechaPublicacion" => "2017-02-01"
      "aid" => "928"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2017;36:77-83"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2731
        "formatos" => array:3 [
          "EPUB" => 189
          "HTML" => 2013
          "PDF" => 529
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "ProACS risk score&#58; An early and simple score for risk stratification of patients with acute coronary syndromes"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "77"
            "paginaFinal" => "83"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "<span class="elsevierStyleItalic">Score</span> de risco ProACS&#58; em <span class="elsevierStyleItalic">score</span> simples e precoce para estratifica&#231;&#227;o de risco em doentes com s&#237;ndromes coron&#225;rias agudas"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1270
                "Ancho" => 1608
                "Tamanyo" => 74518
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Fit of the final multivariate logistic regression model in the development cohort&#46; df&#58; degrees of freedom&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ana Teresa Tim&#243;teo, S&#237;lvia Aguiar Rosa, Marta Afonso Nogueira, Adriana Belo, Rui Cruz Ferreira"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Ana Teresa"
                "apellidos" => "Tim&#243;teo"
              ]
              1 => array:2 [
                "nombre" => "S&#237;lvia"
                "apellidos" => "Aguiar Rosa"
              ]
              2 => array:2 [
                "nombre" => "Marta"
                "apellidos" => "Afonso Nogueira"
              ]
              3 => array:2 [
                "nombre" => "Adriana"
                "apellidos" => "Belo"
              ]
              4 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Cruz Ferreira"
              ]
              5 => array:1 [
                "colaborador" => "on behalf of the ProACS Investigators"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204917300259"
          "doi" => "10.1016/j.repce.2017.02.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300259?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303778?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000002/v1_201702090011/S0870255116303778/v1_201702090011/en/main.assets"
    ]
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "Risk stratification after acute coronary syndromes&#58; Scores&#44; scores and yet another score"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "85"
        "paginaFinal" => "87"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Daniel Ferreira"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Daniel"
            "apellidos" => "Ferreira"
            "email" => array:1 [
              0 => "dferreira&#64;hospitaldaluz&#46;pt"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Cardiovascular Centre&#44; Hospital da Luz Lisboa&#44; Lisbon&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Estratifica&#231;&#227;o de risco ap&#243;s s&#237;ndromes coron&#225;rias agudas&#46; <span class="elsevierStyleItalic">Scores</span>&#44; <span class="elsevierStyleItalic">scores</span> e mais &#40;um&#41; <span class="elsevierStyleItalic">score</span>"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Identification of high-risk patients soon after an acute coronary syndrome &#40;ACS&#41; event has been a challenge for clinicians in the past two or three decades&#46; Numerous studies have clearly demonstrated that more intensive&#44; even aggressive&#44; management of these patients results in significantly better outcomes&#44; in particular in the reduction of major adverse cardiac events&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Both ST-elevation myocardial infarction &#40;STEMI&#41; and non-STEMI &#40;NSTEMI&#41; patients have been the subject of risk stratification studies and a number of risk scores have been proposed&#46; Some of these scores were tested in populations of clinical trials &#40;of which the TIMI scores<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> are the best known&#41;&#44; but others &#40;such as the GRACE score<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a>&#41; were derived from large registries&#44; with the obvious advantages of reflecting real-life patients&#44; including older and sicker patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Identifying high-risk patients</span><p id="par0015" class="elsevierStylePara elsevierViewall">ACS risk scores aim to identify high-risk patients who should be managed with the best available care&#44; in the shortest possible timeframe&#46; This is in contrast with&#44; for example&#44; the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> for non-valvular atrial fibrillation&#44; which aims to identify very low-risk patients who do not need to be anticoagulated&#44; since the risk of cerebral or peripheral embolism is minimal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Early referral of these high-risk ACS patients to reference centers with percutaneous coronary intervention &#40;PCI&#41; capabilities and cardiac intensive care units has been shown to result in better short- and long-term outcomes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Risk stratification can be particularly useful to identify high-risk NSTEMI patients who should be referred for more intensive management at an earlier stage of their ACS episode&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Low-risk patients should be properly treated too</span><p id="par0030" class="elsevierStylePara elsevierViewall">A word of caution for the management of patients stratified as low-risk on presentation shortly after an ACS episode&#44; who should also be referred for the best care possible&#44; particularly those presenting with STEMI&#46; Emergency response services should be ready to provide immediate referral to a PCI center&#44; provided it is available in the timeframe defined by the ACS and PCI guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Do we need yet another score&#63;</span><p id="par0035" class="elsevierStylePara elsevierViewall">All existing risk stratification scores have their strengths and weaknesses&#46; The TIMI scores have been used for some time now but they were derived from clinical trials and their application to real-world patients has been the subject of debate&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The robust GRACE score<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> has the advantage of being based on a large registry&#44; but the disadvantage of including variables that are not available on admission &#40;such as some laboratory results&#41;&#44; meaning that it is not applicable for immediate stratification after presentation in the pre-hospital or emergency room environments&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A more immediately applicable score was proposed in 2013 by Huynh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> based on a Canadian population registry&#46; The Canada Acute Coronary Syndrome &#40;C-ACS&#41; risk score is a simple-to-use score with only four variables &#40;age&#44; Killip class&#44; systolic blood pressure and heart rate&#41; that the investigators have shown enables rapid identification of high-risk patients with ACS&#44; even before biological markers can be obtained&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The question then arises&#58; if we already have good and reliable scores for ACS risk stratification&#44; why would we want yet another score&#63;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The main reason is concern about the applicability of scores derived from populations from North America &#40;US and Canada&#41; to European ACS patients&#46; There are a number of reasons to question this extrapolation&#46; There are relevant epidemiological&#44; genetic&#44; environmental and cultural differences as well as differences in organizational aspects of healthcare systems&#46; Also&#44; ACS management differs considerably between countries on opposite sides of the ocean&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">To resolve this question&#44; in this issue of the <span class="elsevierStyleItalic">Journal</span> Tim&#243;teo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> propose a new score derived from the Portuguese Registry on Acute Coronary Syndromes &#40;ProACS&#41;&#44; a multicenter nationwide ACS registry&#46; It is a prospective&#44; continuous&#44; and observational registry that includes more than 40<span class="elsevierStyleHsp" style=""></span>000 patients from 33 participating cardiology departments in Portugal&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Thus&#44; this study has the advantage of being based on a large&#44; continuous&#44; national ACS registry&#44; that likely reflects local real-world practice&#46; The validation &#40;both internal and external&#41; was well designed&#44; the score&#39;s performance was similar when comparing patients with STEMI and NSTEMI&#44; and its predictive ability was only slightly lower than that of the robust GRACE risk score&#46; The external validation of the score has been previously published in this journal&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Creating a new ACS risk score&#63; Keep it simple</span><p id="par0070" class="elsevierStylePara elsevierViewall">Having learned the lessons of the C-ACS score&#44; Tim&#243;teo et al&#46; designed the ProACS score to be simple to use and without the need for laboratory results&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Simplicity is a key factor for widespread applicability of a risk score&#46; As the authors mention in the discussion&#44; the need to wait for laboratory results has led to the underuse of the GRACE score in daily clinical practice&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The proposed ProACS score can be easily calculated with clinical variables only&#44; and has nonetheless showed good discriminatory ability in the identification of high-risk ACS patients &#40;both STEMI and NSTEMI&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Could we make it even simpler&#63;</span><p id="par0085" class="elsevierStylePara elsevierViewall">As mentioned above&#44; one of the major advantages of the C-ACS score is its simplicity&#44; as it has only four variables to consider&#44; 1 point for each variable and clear cut-off values &#40;age &#8805;75 years&#44; Killip class &#62;1&#44; systolic blood pressure &#60;100 mm Hg&#44; and heart rate &#62;100 beats&#47;min&#41;&#46; Huynh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> could justifiably point out in their conclusions &#8220;Because this risk score is simple and easy to memorize and calculate&#44; it can be rapidly applied by health care professionals without advanced medical training&#46;&#8221;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The ProACS score is also simple to calculate&#44; but the cut-off values for some of the variables are not so easy to memorize&#46; We may wonder if the score&#39;s discriminatory value would decrease significantly if more straightforward numbers were used as cut-offs&#44; e&#46;g&#46; 70 &#40;or 75&#41; instead of 72 years for age and&#47;or 115 mmHg instead of 116 mmHg for systolic blood pressure&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The exact transposition of the multivariate statistical analysis is understandable&#44; but sometimes some loss of discriminatory value &#40;as long as it is only marginal&#41; can be compensated by more user-friendly cut-off variables&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">That being said&#44; the authors of the ProACS score are to be congratulated for their work&#44; which deserves the attention of other investigators in this research area&#46; Validation of their proposed score by other groups in other European countries would be most welcome&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:7 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Identifying high-risk patients"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Low-risk patients should be properly treated too"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Do we need yet another score&#63;"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Creating a new ACS risk score&#63; Keep it simple"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Could we make it even simpler&#63;"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        6 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The TIMI risk score for unstable angina&#47;non-ST-elevation MI&#46; A method for prognostication and therapeutic decision making"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;M&#46; Antman"
                            1 => "M&#46; Cohen"
                            2 => "P&#46;J&#46; Bernink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2000"
                        "volumen" => "284"
                        "paginaInicial" => "835"
                        "paginaFinal" => "842"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10938172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "TIMI risk score for ST-elevation myocardial infarction&#58; a convenient&#44; bedside&#44; clinical score for risk assessment at presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Morrow"
                            1 => "E&#46;M&#46; Antman"
                            2 => "A&#46; Charlesworth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2000"
                        "volumen" => "102"
                        "paginaInicial" => "2031"
                        "paginaFinal" => "2037"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11044416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of hospital mortality in the global registry of acute coronary events"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;B&#46; Granger"
                            1 => "R&#46;J&#46; Goldberg"
                            2 => "O&#46; Dabbous"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinte.163.19.2345"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2003"
                        "volumen" => "163"
                        "paginaInicial" => "2345"
                        "paginaFinal" => "2353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14581255"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A validated prediction model for all forms of acute coronary syndrome&#58; estimating the risk of 6-month postdischarge death in an international registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;A&#46; Eagle"
                            1 => "M&#46;J&#46; Lim"
                            2 => "O&#46;H&#46; Dabbous"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "2004"
                        "volumen" => "291"
                        "paginaInicial" => "2727"
                        "paginaFinal" => "2733"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach&#58; the euro heart survey on atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "R&#46; Nieuwlaat"
                            2 => "R&#46; Pisters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-1584"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "263"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology &#40;ESC&#41;"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Steg"
                            1 => "S&#46;K&#46; James"
                            2 => "D&#46; Atar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs215"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2569"
                        "paginaFinal" => "2619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 ESC&#47;EACTS Guidelines on myocardial revascularization&#58; The Task Force on Myocardial Revascularization of the European Society of Cardiology &#40;ESC&#41; and the European Association for Cardio-Thoracic Surgery &#40;EACTS&#41; Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions &#40;EAPCI&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Windecker"
                            1 => "P&#46; Kolh"
                            2 => "F&#46; Alfonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu278"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "2541"
                        "paginaFinal" => "2619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25173339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Canada Acute Coronary Syndrome Risk Score&#58; a new risk score for early prognostication in acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Huynh"
                            1 => "S&#46; Krouz"
                            2 => "A&#46; Yan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2013.03.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2013"
                        "volumen" => "166"
                        "paginaInicial" => "58"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23816022"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ProACS risk score&#58; an early and simple score for risk stratification of patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Tim&#243;teo"
                            1 => "S&#46; Aguiar Rosa"
                            2 => "M&#46;A&#46; Nogueira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2017"
                        "volumen" => "36"
                        "paginaInicial" => "77"
                        "paginaFinal" => "83"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "External validation of the ProACS score for risk stratification of patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Tim&#243;teo"
                            1 => "S&#46; Aguiar Rosa"
                            2 => "M&#46;A&#46; Nogueira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2015.11.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "323"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27255171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003600000002/v1_201702090011/S087025511630378X/v1_201702090011/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29261"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigos Originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000002/v1_201702090011/S087025511630378X/v1_201702090011/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630378X?idApp=UINPBA00004E"
]
Partilhar
Informação da revista
Vol. 36. Núm. 2.
Páginas 85-87 (fevereiro 2017)
Partilhar
Partilhar
Baixar PDF
Mais opções do artigo
Visitas
5534
Vol. 36. Núm. 2.
Páginas 85-87 (fevereiro 2017)
Editorial comment
Open Access
Risk stratification after acute coronary syndromes: Scores, scores and yet another score
Estratificação de risco após síndromes coronárias agudas. Scores, scores e mais (um) score
Visitas
5534
Daniel Ferreira
Cardiovascular Centre, Hospital da Luz Lisboa, Lisbon, Portugal
Conteúdo relacionado
Ana Teresa Timóteo, Sílvia Aguiar Rosa, Marta Afonso Nogueira, Adriana Belo, Rui Cruz Ferreira
Este item recebeu

Under a Creative Commons license
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Texto Completo

Identification of high-risk patients soon after an acute coronary syndrome (ACS) event has been a challenge for clinicians in the past two or three decades. Numerous studies have clearly demonstrated that more intensive, even aggressive, management of these patients results in significantly better outcomes, in particular in the reduction of major adverse cardiac events.

Both ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients have been the subject of risk stratification studies and a number of risk scores have been proposed. Some of these scores were tested in populations of clinical trials (of which the TIMI scores1,2 are the best known), but others (such as the GRACE score3,4) were derived from large registries, with the obvious advantages of reflecting real-life patients, including older and sicker patients.

Identifying high-risk patients

ACS risk scores aim to identify high-risk patients who should be managed with the best available care, in the shortest possible timeframe. This is in contrast with, for example, the CHA2DS2-VASc score5 for non-valvular atrial fibrillation, which aims to identify very low-risk patients who do not need to be anticoagulated, since the risk of cerebral or peripheral embolism is minimal.

Early referral of these high-risk ACS patients to reference centers with percutaneous coronary intervention (PCI) capabilities and cardiac intensive care units has been shown to result in better short- and long-term outcomes.

Risk stratification can be particularly useful to identify high-risk NSTEMI patients who should be referred for more intensive management at an earlier stage of their ACS episode.

Low-risk patients should be properly treated too

A word of caution for the management of patients stratified as low-risk on presentation shortly after an ACS episode, who should also be referred for the best care possible, particularly those presenting with STEMI. Emergency response services should be ready to provide immediate referral to a PCI center, provided it is available in the timeframe defined by the ACS and PCI guidelines.6,7

Do we need yet another score?

All existing risk stratification scores have their strengths and weaknesses. The TIMI scores have been used for some time now but they were derived from clinical trials and their application to real-world patients has been the subject of debate.

The robust GRACE score3,4 has the advantage of being based on a large registry, but the disadvantage of including variables that are not available on admission (such as some laboratory results), meaning that it is not applicable for immediate stratification after presentation in the pre-hospital or emergency room environments.

A more immediately applicable score was proposed in 2013 by Huynh et al.8 based on a Canadian population registry. The Canada Acute Coronary Syndrome (C-ACS) risk score is a simple-to-use score with only four variables (age, Killip class, systolic blood pressure and heart rate) that the investigators have shown enables rapid identification of high-risk patients with ACS, even before biological markers can be obtained.

The question then arises: if we already have good and reliable scores for ACS risk stratification, why would we want yet another score?

The main reason is concern about the applicability of scores derived from populations from North America (US and Canada) to European ACS patients. There are a number of reasons to question this extrapolation. There are relevant epidemiological, genetic, environmental and cultural differences as well as differences in organizational aspects of healthcare systems. Also, ACS management differs considerably between countries on opposite sides of the ocean.

To resolve this question, in this issue of the Journal Timóteo et al.9 propose a new score derived from the Portuguese Registry on Acute Coronary Syndromes (ProACS), a multicenter nationwide ACS registry. It is a prospective, continuous, and observational registry that includes more than 40000 patients from 33 participating cardiology departments in Portugal.

Thus, this study has the advantage of being based on a large, continuous, national ACS registry, that likely reflects local real-world practice. The validation (both internal and external) was well designed, the score's performance was similar when comparing patients with STEMI and NSTEMI, and its predictive ability was only slightly lower than that of the robust GRACE risk score. The external validation of the score has been previously published in this journal.10

Creating a new ACS risk score? Keep it simple

Having learned the lessons of the C-ACS score, Timóteo et al. designed the ProACS score to be simple to use and without the need for laboratory results.

Simplicity is a key factor for widespread applicability of a risk score. As the authors mention in the discussion, the need to wait for laboratory results has led to the underuse of the GRACE score in daily clinical practice.

The proposed ProACS score can be easily calculated with clinical variables only, and has nonetheless showed good discriminatory ability in the identification of high-risk ACS patients (both STEMI and NSTEMI).

Could we make it even simpler?

As mentioned above, one of the major advantages of the C-ACS score is its simplicity, as it has only four variables to consider, 1 point for each variable and clear cut-off values (age ≥75 years, Killip class >1, systolic blood pressure <100 mm Hg, and heart rate >100 beats/min). Huynh et al.8 could justifiably point out in their conclusions “Because this risk score is simple and easy to memorize and calculate, it can be rapidly applied by health care professionals without advanced medical training.”

The ProACS score is also simple to calculate, but the cut-off values for some of the variables are not so easy to memorize. We may wonder if the score's discriminatory value would decrease significantly if more straightforward numbers were used as cut-offs, e.g. 70 (or 75) instead of 72 years for age and/or 115 mmHg instead of 116 mmHg for systolic blood pressure.

The exact transposition of the multivariate statistical analysis is understandable, but sometimes some loss of discriminatory value (as long as it is only marginal) can be compensated by more user-friendly cut-off variables.

That being said, the authors of the ProACS score are to be congratulated for their work, which deserves the attention of other investigators in this research area. Validation of their proposed score by other groups in other European countries would be most welcome.

Conflicts of interest

The author has no conflicts of interest to declare.

References
[1]
E.M. Antman, M. Cohen, P.J. Bernink, et al.
The TIMI risk score for unstable angina/non-ST-elevation MI. A method for prognostication and therapeutic decision making.
JAMA, 284 (2000), pp. 835-842
[2]
D.A. Morrow, E.M. Antman, A. Charlesworth, et al.
TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation.
Circulation, 102 (2000), pp. 2031-2037
[3]
C.B. Granger, R.J. Goldberg, O. Dabbous, et al.
Predictors of hospital mortality in the global registry of acute coronary events.
Arch Intern Med, 163 (2003), pp. 2345-2353
[4]
K.A. Eagle, M.J. Lim, O.H. Dabbous, et al.
A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.
J Am Med Assoc, 291 (2004), pp. 2727-2733
[5]
G.Y. Lip, R. Nieuwlaat, R. Pisters, et al.
Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
Chest, 137 (2010), pp. 263-272
[6]
G. Steg, S.K. James, D. Atar, Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), et al.
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
Eur Heart J, 33 (2012), pp. 2569-2619
[7]
S. Windecker, P. Kolh, F. Alfonso, et al.
2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
Eur Heart J, 35 (2014), pp. 2541-2619
[8]
T. Huynh, S. Krouz, A. Yan, et al.
Canada Acute Coronary Syndrome Risk Score: a new risk score for early prognostication in acute coronary syndromes.
Am Heart J, 166 (2013), pp. 58-63
[9]
A.T. Timóteo, S. Aguiar Rosa, M.A. Nogueira, et al.
ProACS risk score: an early and simple score for risk stratification of patients with acute coronary syndromes.
Rev Port Cardiol, 36 (2017), pp. 77-83
[10]
A.T. Timóteo, S. Aguiar Rosa, M.A. Nogueira, et al.
External validation of the ProACS score for risk stratification of patients with acute coronary syndromes.
Rev Port Cardiol, 35 (2016), pp. 323-328
Copyright © 2016. Sociedade Portuguesa de Cardiologia
Baixar PDF
Idiomas
Revista Portuguesa de Cardiologia
Opções de artigo
Ferramentas
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.