Risk stratification in acute coronary syndrome

Background: The spectrum of symptoms of patients with active ischemic heart disease ranges from silent ischemia to acute myocardial infarction and the extent of myocardial damage from reversible myocardial injury to extensive necrosis. The term "acute coronary syndrome" comprises this continuum. In particular the evaluation of patients without ST-segment elevation is diffi cult, for clinical symptoms, ECG criteria and CK-MB measurements appear ins ufficient for appropriate risk stratification. Troponin Measurement: Serial measurements of either troponin T or I reliabl y detect minor myocardial damage in those patients, who are known to be at a higher risk for adverse cardiac events comparable to the risk of patients with acute myocardial infarction. Hence determination of troponins allow s uperior risk stratification contributing to early triage and therapeutic de cision making. Without elevation of troponins the cardiac risk for death or myocardial infarction will not exceed 1%. Conclusion: Patients with elevated troponins should be early hospitalized a nd further evaluated in order to begin efficacious therapy as soon as possi ble. These patients represent a high-risk subgroup of patients clinically c lassified as unstable angina, who might benefit from potential antithrombot ic treatment such as low-molecular weight heparin or glycoprotein IIb/IIIa antagonists without or with revascularization strategies.