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1. INTRODUCTION

Acute coronary syndromes affect millions of individuals annually by causing

considerable morbidity and mortality. In developed countries this disease remains the

number one killer, despite significant improvements in its management over the last

several decades. The American Heart Association estimates that 1.1 million

myocardial infarctions occur in the United States alone and that !" of these patients

#ill die. Taken together #ith corresponding $gures for myocardial infarction in the

U%, these data suggest that the incidence of A&I is in the range of 1 per '(! to 1 per

(!! of the population per year. The prevalence of coronary artery disease )*A+ is

increasing rapidly in non-industrialied countries. )*hristian /. H.et al, '!!0.

lobally, appro2imately 1!31( million individuals die each year from

cardiovascular disease, accounting for appro2imately one-third of all deaths. The

/orld Health 4rganiation )/H4 has pro5ected that the number of deaths

attributable to cardiovascular disease #ill continue to increase to the year '!6!, #hile

deaths from communicable causes #ill continue to decline. )&athers *+, '!!0

In &yanmar population, among the cardiovascular disease, acute coronary

syndrome has become an emerging problem over the past fe# years, as is evident by

the admission of (70 patients in '!!0 and (08 patients in '!!8 to coronary care units

of 9H. It has been observed to affect not only the older age group, but also the

younger population during the past years.

The acute coronary syndromes )A*S encompass a spectrum of unstable

coronary artery disease from unstable angina to transmural myocardial infarction.

All have a common aetiology in the formation of thrombus on an inflamed and

complicated atheromatous pla:ue. The principles behind the presentation,

investigation and management of these syndromes are similar #ith important

distinctions depending on the category of acute coronary syndrome. )SI;, '!1'

There are several clinical risk stratification scoring systems that can predict

death or myocardial infarction in patients #ith acute coronary syndromes< the most

commonly used scores include =A*>, TI&I and ?U=SUIT. All are derived from

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=*T populations e2cept the =A*> registry #hich is obtained from an

international @real life observational registry. It provides a unified scoring system

for both ST elevation and non-ST elevation A*S. In prospective evaluations, the

=A*> registry #as the most predictive of outcome and has been validated using

independent e2ternal datasets.

The =A*> risk prediction model, designed to predict in hospital mortality,

#as developed from an earlier cohort of =A*> patients )a total of 11,6B7 patients

enrolled in 1 countries from April 1, 1777, to &arch 61, '!!1. The components of

the =A*> =isk Score are age, heart rate, systolic blood pressure, %illip class,

cardiac arrest, ST segment deviation, serum creatinine, and initial cardiac biomarker

status. All variables are recorded on presentation. The ob5ective of =A*> study

#as to investigate the use of revascularisation strategies according to the risk status

of the patients at presentation.=A*> risk score has a better predictive accuracyfor outcomes than either the Thrombolysis in &yocardial Infarction )TI&I or ?latelet

lycoprotein IIbCIIIa in Unstable Angina< =eceptor Suppression Using Integrelin

Therapy )?U=SUIT risk scores. )ranger * .D , et al, '!!6.

Eo2, %.A.A., et. al., in study of ',1B7 patients #ith acute coronary syndrome

described that systematic and accurate risk stratification may allo# higher-risk

patients to be selected for revascularisation procedures, in contrast to current

international practice in '!!8. In '!!7, Dasem >lbarouni, et al., conducted 1',''patients #ith A*S and concluded that =A*> risk score is a valid and po#erful

predictor of adverse outcomes across the #ide range of *anadian patients #ith A*S.

Fuis, *.F.*., et. al., in '!1! sho#ed that the prediction of hospital events in patients

#ith A*S, the =A*> score has superior prognostic capacity #hen compared to the

TI&I score. Dabarskiene, &.=., et. al., in '!11 stated that prognostic value of the

=A*> risk score #as better for ST>&I patients #ho had intervention treatment

during their hospital stay than for those #ho did not.

The purpose of this study is to assess usefulness of =A*> risk score in

&yanmar population, to assess the severity of acute coronary syndrome by =A*>

score.

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