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BACKGROUND: Despite the availability of several acute coronary syndrome (ACS) prognostic risk scores (RSs), there is no appropriate score for post-discharge risk stratification for patients after ACS. The aim of this study was to improve traditional RSs designed for predicting short-term outcome after ACS through the inclusion of additional prognostic factors critical for long-term prognosis. METHODS: Observational prospective single-center study included 672 consecutive patients admitted for ACS and discharged alive between 2002 and 2004. Multivariate analysis identified additional independent risk factors for long-term mortality, primarily not included in the RSs. Prognostic value of each RS (SIMPLE, TIMI-STEMI, TIMI-UA/NSTEMI, GRACE in-hospital, GRACE post-discharge, ZWOLLE, LLOYD-JONES) with additional risk factors was evaluated with the area under receiver operating characteristics (ROC) curve. RESULTS: Multivariate analysis identified following independent risk factors improving prognostic value of each RS: supraventricular or ventricular arrhythmias during hospitalization (for all six scales), peripheral artery disease, male gender, recurrence of angina pectoris with ischemia on ECG (in the case of five scales), diabetes, heart failure (for four scales), multi-vessel coronary disease, impaired renal function (in three scales) and less frequent indicators: hospital discharge, coronary artery disease, dyslipidemia, resuscitated sudden cardiac arrest. CONCLUSION: Additional clinical parameters initially not included in the description of the ACS risk scores provided independent prognostic value, whereby improved global risk assessment. Taking these factors into consideration may improve risk stratification of ACS patients.