Key result
Integrated multimarker risk stratification improves ACS prognostic assessment over single markers alone.
Why the study?
Despite advances in coronary revascularization and pharmacological treatment, patients with ACS remain at risk of serious complications, making early identification of high-risk patients essential for optimizing clinical management.
Combining clinical indicators, ECG findings, cardiac biomarkers, echocardiography, and validated risk scores like the GRACE score provides a comprehensive early risk stratification to guide timely therapeutic decisions in acute coronary syndrome.
May aid early ACS risk stratification; narrative synthesis leaves open which markers best guide therapy.
Background: Acute coronary syndrome (ACS) is a major cause of cardiovascular morbidity and mortality. Despite advances in coronary revascularization and pharmacological treatment, patients remain at risk of serious complications, including acute heart failure, malignant arrhythmias, cardiogenic shock, and death. Early identification of high-risk patients is therefore essential for optimizing clinical management. Objective: To review the major clinical, electrocardiographic, laboratory, and echocardiographic indicators associated with adverse outcomes in patients with acute coronary syndrome and to describe their role in early risk stratification. Materials and Methods: A narrative review approach was used to organize evidence concerning clinical assessment, cardiovascular biomarkers, electrocardiographic abnormalities, left ventricular function, and validated prognostic scoring systems. Particular attention was given to contemporary recommendations for the management of ACS. Results and Discussion: Advanced age, hypotension, tachycardia, delayed presentation, signs of heart failure, elevated cardiac troponin concentrations, and reduced left ventricular ejection fraction are important indicators of an unfavorable prognosis. Electrocardiographic changes and the extent of coronary artery disease provide additional information regarding myocardial injury and the likelihood of complications. The GRACE risk score is a validated tool for estimating mortality risk, while echocardiography helps identify ventricular dysfunction and mechanical complications. Combining these parameters provides a more comprehensive assessment than relying on a single clinical or laboratory marker. Conclusion: Early, integrated risk stratification is an essential component of ACS management. Systematic assessment of clinical status, ECG findings, cardiac biomarkers, renal function, and ventricular performance can support timely therapeutic decisions and individualized follow-up. Prospective studies are needed to evaluate how integrated risk assessment strategies affect clinical outcomes in different patient populations. .
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Tashmatova et al. (2026) conducted a review in Acute coronary syndrome. Early integrated risk stratification (clinical status, ECG, cardiac biomarkers, GRACE score, and echocardiography) vs. Single clinical or laboratory marker was evaluated on Adverse outcomes including acute heart failure, malignant arrhythmias, cardiogenic shock, and mortality. Integrated risk stratification combining clinical status, ECG, troponin, GRACE score, and LVEF provides a more comprehensive prognostic assessment in ACS than single markers.
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