Both fibrinolysis and primary PCI were associ- ated with higher bleeding rates in patients with severely reduced Progressive renal dysfunction is a strong pre- dictor of bleeding with antithrombotic therapy, a risk that may reflect intrinsic renal dysfunction and/or failure to adjust or avoid antithrombotic medications that are dependent on renal 2.3. Early Risk Assessment Global risk assessment provides an opportunity to integrate various patient characteristics into a semiquantitative score that can convey an overall estimate of a patient s prognosis; can dictate the acuity, intensity, and location of care; and can provide the patient and family with a more informed sense of potential outcome. Higher risk scores generally imply that higher-intensity treatments may be appropriate within the context of the patient s health status. Some of the independent predictors of early death from STEMI include age, Killip class, time to reperfusion, cardiac arrest, tachycardia, hypotension, anterior infarct location, prior infarction, diabetes mellitus, smoking status, renal func- tion, and biomarker findings.48,49 Whereas the Thrombolysis In Myocardial Infarction (TIMI) risk score was developed specifically in patients with STEMI (http://www.mdcalc.com/ timi-risk-score-for-stemi), the GRACE model (http://www. outcomes-umassmed.org/grace/acs_risk/acs_risk_content. html) predicts in-hospital and 6-month mortality rate across the spectrum of patients presenting with ACS, including those with ST elevation or ST depression. Risk assessment is a con- tinuous process that should be repeated throughout hospital- ization and at time of discharge. 3. Onset of MI 3.1. 