NSTEMI - Risk Scores and Treatment
Non ST Segment Elevation Myocardial Infarction, also known as NSTEMI is a type of heart attack.
NSTEMIs usually results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material.
NSTEMIs are one type of heart attack - there are two others:
1) ST segment elevation myocardial infarction (STEMI)
2) Unstable angina
A STEMI results from complete and prolonged occlusion of an epicardial coronary blood vessel and is defined based on ECG criteria, while unstable angina (chest discomfort caused by poor blood flow through the vessels) is a condition in which your heart does not get enough blood flow and oxygen which may lead to a heart attack.
While STEMI treatment consists of urgent angiogram with likely stent placement, NSTEMI and unstable angina treatment is different and and much of the time the patient is not treated properly resulting in a STEMI.
There are several risk scores that can be used to evaluate patients who are having an NSTEMI or unstable angina to see if they qualify for more invasive treatment.
One such risk score is the TIMI scale. One point is given for each of the following:
being older than 65
using aspirin within the last week
having at least two angina episodes in the last 24 hours
having elevated serum cardiac biomarkers
having ST-segment deviation on an electrocardiogram (a type of heart test)
having known coronary artery disease
having at least three risk factors for heart disease, which include:
high blood pressure (greater than 140/90)
smoking (being a current smoker)
low HDL cholesterol (less than 40 mg/dL)
a family history of heart disease
The lowest score a patient can receive is a 0, and the highest is a 7. Based on the TIMI score the healthcare provider can determine risk for coronary event and implement a treatment plan.
Many times patients are discharged from the hospital with an NSTEMI without any risk score evaluation or other interventions resulting in the patient suffering a STEMI with can lead to serious heart damage or even death.
It is important that all NSTEMIs and unstable angina be taken seriously to prevent unnecessary negative outcomes.