Impact of Risk Stratification on Clinical Outcomes in Patients With Acute Coronary Syndrome　- A Systematic Review.

Background: Risk scores have been developed to determine the treatment strategies and predict the prognosis of acute coronary syndromes (ACS). It remains unclear whether risk score-guided management improves prognosis. Therefore, this systematic review aimed to evaluate whether the use of risk scores to assess the acute severity of illness affects the prognosis of adult patients with ACS. Methods and Results: We conducted a systematic review and meta-analysis to evaluate whether risk score-guided management improves clinical outcomes in patients with ACS. We searched MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to November 30, 2024, and included randomized controlled trials comparing risk score-based care with standard care. Two cluster randomized trials, using the Global Registry of Acute Coronary Events risk score (GRS), were identified, with a total of 5,368 patients. A systematic review adjusted for clustering revealed no significant differences in clinical outcomes, including in-hospital and 1-year mortality, in-hospital cardiac arrest, in-hospital recurrent ischemia, in-hospital and 1-year heart failure, and early invasive angiography. Conclusions: Risk score-guided management of patients with ACS using risk scores, particularly the GRS, did not consistently lead to improved clinical outcomes. Further research is needed to assess whether risk score-guided management can improve patient outcomes.