Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

Abstract

The GRACE score constitutes a useful tool for risk stratification in patients with acute coronary syndrome (ACS), while the SYNTAX score determines the complexity of coronary artery disease (CAD). This study sought to correlate these scores and assess the accuracy of the GRACE score in predicting the extent of CAD. A total of 539 patients with ACS undergoing coronary angiography were included in this analysis. The patients were classified into those with a SYNTAX score < 33 and a SYNTAX score ≥ 33. Spearman’s correlation and receiver operator characteristic analysis were conducted to investigate the role of the GRACE score as a predictor of the SYNTAX score. There was a significantly positive correlation between the SYNTAX and the GRACE scores (r = 0.32, p < 0.001). The GRACE score predicted severe CAD (SYNTAX ≥ 33) moderately well (the area under the curve was 0.595 (0.522–0.667)). A GRACE score of 126 was documented as the optimal cut-off for the prediction of a SYNTAX score ≥ 33 (sensitivity = 53.5% and specificity = 66%). Therefore, our study reports a significantly positive correlation between the GRACE and the SYNTAX score in patients with ACS. Notably, NSTEMI patients with a high-risk coronary anatomy have higher calculated GRACE scores. A multidisciplinary approach by a heart team could possibly alter the therapeutic approach and management in patients presenting with ACS and a high calculated GRACE score.

Left atrial strain predicts risk and prognosis in patients with acute coronary syndrome: A retrospective study with external validation

“…These findings also suggest that patients with a higher GRACE score have worse cardiac function, more complex coronary lesions, and a worse prognosis. Several previous studies have discovered that patients with high-risk coronary anatomy had a higher GRACE score, which is consistent with our findings [ 29 , 30 ].…”

Relation of GRACE Risk Score to Coronary Lipid Core Plaques in Patients with Acute Coronary Syndrome

“…Thus, ACS patients with high GRACE risk score may be likely to have vulnerable coronary plaques given the high rates of ischemic events including death and MI in the previous studies [ 9 , 35 ], and the fact that coronary plaque rupture of LCP is the most frequent cause of spontaneous MI, which is defined as disruption of the accumulation of acellular, lipid-rich material in the intima [ 11 , 12 ]. Previous reports showed that the higher GRACE risk score was associated with the higher coronary anatomical complexity using angiographic scoring systems (e.g., SYNTAX and Gensini scores) [ 15 , 16 , 17 ]. For instance, Cakar et al showed that among patients with non-ST segment elevation ACS, the higher GRACE risk score was associated with a higher Gensini score and a higher likelihood of having multivessel disease [ 17 ].…”

“…The identification of vulnerable patients and lesions can lead to intensive therapeutic managements including a lipid-lowering therapy, potentially resulting in a relevant prognostic benefit as a secondary prevention in patients with ACS [ 14 ]. However, only a few studies have indirectly addressed the relation between GRACE risk score and coronary atherosclerosis using angiographic scoring systems such as the SYNTAX and Gensini scores [ 15 , 16 , 17 ]. For instance, a single-center, cross-sectional study showed that among patients with ACS, the GRACE risk score was positively correlated with the SYNTAX score ( r = 0.32, p < 0.001) [ 15 ], indicating that patients with the higher GRACE risk score are likely to have more complex coronary lesions, although the angiographic assessment does not directly provide information on coronary lipid plaques.…”

“…However, only a few studies have indirectly addressed the relation between GRACE risk score and coronary atherosclerosis using angiographic scoring systems such as the SYNTAX and Gensini scores [ 15 , 16 , 17 ]. For instance, a single-center, cross-sectional study showed that among patients with ACS, the GRACE risk score was positively correlated with the SYNTAX score ( r = 0.32, p < 0.001) [ 15 ], indicating that patients with the higher GRACE risk score are likely to have more complex coronary lesions, although the angiographic assessment does not directly provide information on coronary lipid plaques. Recently, near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) has emerged as a unique intracoronary imaging modality to specifically detect lipid core plaques (LCP) and quantify coronary lipid accumulation.…”

Prognostic value of GRACE risk score in patients hospitalized for coronavirus disease 2019

“…In recent years, Global Registry of Acute Coronary Events (GRACE) risk score has been increasingly used to assess short- and long-term outcomes in patients with acute coronary syndrome (ACS). Current American and European guidelines recommend using the GRACE risk score as a predictor of major adverse events in patients with non-ST segment elevation myocardial infarction (MI) patients [8,9]. This risk stratification model, which consists of a variety of clinical, electrocardiographic and laboratory parameters that are documented on admission, is commonly used in clinical practice to estimate the risk of death or MI within 6 months, including inhospital events [10].…”