Method of determining risk of an adverse cardiac event

A method of identifying and treating a mammal at risk of an adverse cardiovascular event or death, wherein the mammal is not an ST-elevation myocardial infarction patient and the adverse cardiovascular event is selected from myocardial infarction, cardiac ischemia, heart failure, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG)), said method comprises the steps of:

• i) detecting in a biological sample obtained from the mammal on presentation of symptoms of acute coronary syndrome, glucose at a concentration greater than 5.5 mmol/L and allotting a score of 1;
• ii) detecting in the biological sample obtained from the mammal on presentation of symptoms of acute coronary syndrome the level of a renal function biomarker selected from creatinine or cystatin c and allotting a score of 1 when the estimated glomerular filtration rate (eGFR) which is based on the level of the renal function biomarker is less than the normal level of eGFR;
• iii) detecting in the biological sample obtained from the mammal on presentation of symptoms of acute coronary syndrome the level of at least one biomarker of cardiac injury selected from cardiac troponin T (cTnT) and cardiac troponin I (cTnI) using a high sensitivity assay or a sensitivity assay and allotting a score of 1 if the level is greater than the level of an ambulatory population at risk for future cardiovascular events but less than the level at which analytical variation occurs, allotting a score of 2 if the level is greater than the level at which analytical variation occurs and less than the upper limit of normal of a general population, and allotting a score of 3 if the level is greater than the upper limit of normal of the general population;
• iv) generating a total laboratory score based on the sum of the scores for each of the biomarkers of i), ii) and iii), and identifying mammals at risk of an adverse cardiac event or death having a laboratory score of greater than 4, wherein the method exhibits a negative likelihood ratio of less than 1 with a sensitivity of about 99%, and a positive likelihood ratio of at least 5 with a specificity at least about 90%;
• and
• v) administering a treatment to said mammals, wherein the treatment is selected from the group consisting of:
• administration of an anticoagulant, a thrombolytic, nitroglycerin, an antiplatelet drug, a beta blocker, an alpha and beta-blocker combination, a calcium channel blocker, an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin-receptor blocker, an angiotensin-receptor neprilysin inhibitor, a cholesterol-lowering medication, a vasodilator, and/or a diuretic;
• angioplasty and stenting;
• and coronary bypass surgery.