Using the GRACE Score to Assess Long-term Risk in Patients with Non-ST Elevation Acute Coronary Syndrome
Objective of the Study: To assess the possibility of predicting long-term unfavorable outcomes in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), using the Global Registry of Acute Coronary Events (GRACE). Study Design: It was a general-population prospective registry study. Materials and Methods: A registry of NSTE-ACS patients was established, containing 415 patients. The patients were divided into the following three groups, based on their six-month risk as assessed by GRACE score: low risk (<89 points), moderate/intermediate risk (89-118 points), and high risk (>118 points). The observation period was 68 ± 4 months. During this period, information about outcomes was collected from 396 patients with NSTE-ACS. The following parameters were assessed: the frequency of a hard endpoint (death or a non-fatal myocardial infarction [MI]) at one year and during a six-year observation period and the frequency of a composite endpoint (all hospitalizations for MI, cerebrovascular accidents, unstable angina, and death). Study Results: The study showed that high risk of death and MI within the first six months after NSTE-ACS was present mainly in older women with a history of cardiovascular disorders. During the entire observation period, death/MI occurred more often in patients with high six-month risk of unfavorable outcomes as assessed by GRACE score. Multivariate analysis showed that high six-month GRACE risk score (>120 points), low left ventricular ejection fraction (<47%), and multifocal atherosclerosis were the most significant predictors of death/ MI within the first six years after NSTE-ACS. Conclusion: The six-month GRACE risk score is a good risk stratification tool, which helps effectively identify patients with high risk of adverse events within 68 months after NSTE-ACS. Such patients have a history of cardiovascular disorders and need active treatment to promote myocardial revascularization.