Acute coronary syndrome: the challenge of identifying low-risk patients

Alistair TM Hamilton, Louise Cullen



Reliable identification of patients who have presented with symptoms of ACS and are at low risk for serious clinical events is beneficial to both patients and the healthcare system. Methods to achieve this are needed as clinical gestalt alone cannot reliably define those patients with serious clinical event rates below 1% at 30 days.

Key Points

  • Acute coronary syndrome (ACS) comprises both acute myocardial infarction and unstable angina.
  • Clinical gestalt cannot be reliably used to exclude ACS in patients in whom the diagnosis is considered.
  • General practitioner assessment of the patient with possible ACS comprises early ECG, rapid clinical assessment and referral to a hospital emergency department.
  • Definitive risk stratification includes serial troponin testing.

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