PURSUIT risk score

Definition and History

The PURSUIT (Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy) risk score was developed in a randomized clinical trial which recruited 9,461 patients and compared eptifibatide (Integrilin) to placebo in the management of Unstable Angina (UA) or Non-ST elevation Myocardial Infarction (NSTEMI).

Function

• By using multivariate regression analysis, the investigators established seven risk predictors for death and myocardial infarction (MI) in patients with acute coronary syndromes.
• Five of these risk factors were then combined into a scoring system:
  • Higher age
  • Sex
  • Worst Canadian Cardiovascular Society (CCS) class of angina
  • Signs of heart failure
  • ST-segment depression on the index ECG
• Each of these elements is scored accordingly, resulting in a score ranging 1 - 18.

PURSUIT Risk Score

Elements	Entry	Score
Age	50 60 70 80	8 9 11 12
Sex	Male Female	1 0
Worst CCS class past 6 weeks	No angina/CCS I/II CCS III/IV	0 2
Signs of heart failure		2
ST depression on ECG		1

Interpretation

• The PURSUIT score predicts the risk of death or death/MI at 30 days after admission.
• ACS patients are divided into low, intermediate, and high risk patients, with suggested therapies of early discharge, watchful waiting, and aggressive antiplatelet / early invasive strategies, respectively.