Risk Stratification And Prognostic Value Of GRACE Risk Score For Patients With UA/NSTEMI

Background: The GRACE score "Global registry of acute coronary events" is identified as factors that were associated independently with increased mortality and include increased age, Killip class, increased heart rate, ST segment depression, sign of heart failure lower systolic pressure, cardiac arrest at presentation and elevated serum creatinine or cardiac marker enzyme. Aim of Study: To assess the prognostic value of GRACE score in patients with UA/NSTEMI. Patients and Methods: A prospective study of 187 patients admitted to IBN-ALBITAR Center for Cardiac Surgery in the period from February 2016 to January 2017 with provisional diagnosis of UA/NSTEMI. Full assessment of these patients done including history taking, clinical examination, serum cardiac marker, serum creatinine, non-invasive investigation including electrocardiography, echocardiography. GRACE score was calculated for each patients. All patients included in the study underwent coronary angiography according to the decision of treating physician. Syntax score was calculated for each patient and the line of management was decided accordincally either medical or invasive revascularization by PCI or CABG. A follow up for death, stroke, nonfatal MI and repeat revascularization was done in hospital, one month and six month respectively. Results: Of 187 patients included in the study 102 (54.5%) were male, and 85 (45.5%) female, mean age was 54.3±7 years, diabetes was found in 56 (34.7%) patients, hypertension in 84 (45%) patients, smoking 100 (53.6%) patients. According to GRACE score those patients were classified into low risk score (76) patients, intermediate risk score (65) patients and high risk score (46) patients respectively. Based on syntax score all patients reclassified into low syntax score (98) patients, intermediate syntax score (66) patients and high syntax score (23) patients. The clinical decision and type of management of each patient was decided by his treating senior physician into medical treatment 76 (40.6%), PCI 77 (41.2%) and CABG 34 (18.2%). Upon follow up since in hospital admission and at one month, 6th months respectively there was significant positive relationship between the MACE and GRACE risk score at that period and being highest with those of high GRACE score. Conclusion:- The GRACE score has significant predictive value in risk stratification and prognosis of patients with UA and NSTEMI.