Scoring Systems

There are 2 main used: TIMI and GRACE.  Online calculators are available for both:

TIMI:

http://www.timi.org/?page_id=294

GRACE

http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html

Grace is also available to download for iPhone/iPad app: follow the link above.

NICE Guidelines: Unstable Angina

http://www.nice.org.uk/nicemedia/live/12949/47924/47924.pdf

Take home points for the ED

• assess cardiovascular risk using a recognised scoring system eg TIMI or GRACE (see links below)
• Bloods (including troponins at time of presentation if ECG changes- but don’t use to exclude ACS!)
• Offer aspirin 300mg to everyone except those with hypersensitivity – then consider clopidogrel
• Offer clopidogrel if >=1.5% predicted 6 month mortality
• Offer fondaparinux to patients without a high bleeding risk unless angiography is planned within 24 hours
• Offer unfractionated heparin if angiography is likely within 24 hours