Incremental Prognostic Value of the Incorporation of Clinical Data Into Coronary Anatomy Data in Acute Coronary Syndromes: SYNTAX-GRACE Score

Abstract

BackgroundWhen performing coronary angiography in patients with acute coronary syndrome (ACS), the anatomical extent of coronary disease usually prevails in the prognostic reasoning. It has not yet been proven if clinical data should be accounted for in risk stratification together with anatomical data.ObjectiveTo test the hypothesis that clinical data increment the prognostic value of anatomical data in patients with ACS.MethodsPatients admitted with objective criteria for ACS and who underwent angiography during hospitalization were included. Primary outcome was defined as in-hospital cardiovascular death, and the prognostic value of the SYNTAX Score (anatomical data) was compared to that of the SYNTAX-GRACE Score, which resulted from the incorporation of the GRACE Score into the SYNTAX score. The Integrated Discrimination Improvement (IDI) was calculated to evaluate the SYNTAX-GRACE Score ability to correctly reclassify information from the traditional SYNTAX model.ResultsThis study assessed 365 patients (mean age, 64 ± 14 years; 58% male). In-hospital cardiovascular mortality was 4.4%, and the SYNTAX Score was a predictor of that outcome with a C-statistic of 0.81 (95% CI: 0.70 - 0.92; p < 0.001). The GRACE Score was a predictor of in-hospital cardiac death independently of the SYNTAX Score (p < 0.001, logistic regression). After incorporation into the predictive model, the GRACE Score increased the discrimination capacity of the SYNTAX Score from 0.81 to 0.92 (95% CI: 0.87 - 0.96; p = 0.04).ConclusionIn patients with ACS, clinical data complement the prognostic value of coronary anatomy. Risk stratification should be based on the clinical-anatomical paradigm, rather than on angiographic data only.

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

“…Both scores have been found to independently predict cardiovascular death in patients with ACS [32][33][34][35]. Moreover, a combination of the two algorithms (SYNTAX-GRACE score) has also been described and revealed to be of higher prognostic value for in-hospital cardiovascular death compared to the SYNTAX score alone [33].…”

Out of sight, out of scores!

“…Nonetheless, the most relevant limitation of the study, even if not its primary objective, is that it failed to assess clinical outcomes which goes beyond clinical or angiographic complexity alone. In Brazil, we have an interesting study along these lines, recently published by Viana et al According to the authors, when incorporated into the predictive model, the GRACE was able to increase the discriminatory capacity of the SYNTAX from 0.81 to 0.92 (95%CI 0.87-0.96; p=0.04), 14 suggesting a risk stratification based on the clinical-anatomical paradigm rather than clinical or angiographic data alone.…”

The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction

“…In a study to identify predictors of HRCA in patients with UA/NSTEMI undergoing early angiography, GRACE score of N140 was the strongest predictors of HRCA [14] . The GRACE score could be successfully added to the SYNTAX score to improve its risk stratification ability and aid in predicting the clinical outcome of the patients after revascularization, including in-hospital mortality [15] .…”