Risk assessment
Formally assess individual risk of future adverse cardiovascular events using an established risk scoring system that predicts 6-month mortality (for exampleGRACE).

Include in the formal risk assessment:
a full clinical history (including age, previous myocardial infarction and previous PCI or CABG)
a physical examination (including measurement of blood pressure and heart rate)
resting 12-lead ECG (looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia)
blood tests (such as troponin I or T, creatinine, glucose and haemoglobin).
Record the results of the risk assessment in the patient’s care record.

Use the risk assessment to guide clinical management, and balance the benefit of a treatment against any risk of related adverse events in the light of this assessment.

Use predicted 6-month mortality to categorise the risk of future adverse cardiovascular events as follows:
Predicted 6-monthmortality. Risk of future adverse cardiovascular events
1.5% or below Lowest
>1.5 to 3.0% Low
>3.0 to 6.0% Intermediate
>6.0 to 9.0% High
over 9.0% Highest.

Assessing left ventricular function
Assess left ventricular function in all patients who have had a myocardial infarction.

Consider assessing left ventricular function in all patients with unstable angina.

G Mohan.