Patients with ACS are a heterogeneous population with varying degrees of atherosclerotic disease and thrombotic risk and, therefore, varying mortality and recurrent cardiac event rates. In order to select the most appropriate treatment, early and repeated risk stratification should be performed since the benefit from certain aggressive treatment strategies is related to risk – the higher the risk, the greater the benefit.

As per NICE, as soon as the diagnosis of unstable angina or NSTEMI is made, and aspirin and antithrombin therapy have been offered, formally assess individual risk of future adverse cardiovascular events using an established risk scoring system that predicts 6‑month mortality (for example, Global Registry of Acute Cardiac Events [GRACE]) [3].

A formal risk assessment should include a full clinical history (including age, previous myocardial infarction [MI] and previous PCI or coronary artery bypass grafting [CABG]), a physical examination (including measurement of blood pressure and heart rate), a resting 12‑lead ECG, looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia, blood tests (such as troponin I or T, creatinine, glucose and haemoglobin).