GRACE score also predicts anatomic complexity of coronary artery disease patients presenting with non-STEMI

Acute Coronary Syndromes (ACS) represent the most common cause of death in the western world. We retrospectively screened data of non-STEMI patients admitted to the coronary care unit of a tertiary center between March 2015 and March 2016. GRACE score was calculated and patients were classified into low (1 to 108), intermediate (109 to 140) and high risk (>40) groups according to GRACE categories. SYNTAX scores were also calculated. 201 patients (mean age: 63 ± 12 years, 53.7% female) were admitted with a diagnosis of non-STEMI. The mean GRACE score and SYNTAX score of study population were 105 ± 34.1 and 16.9 ± 12. Based on the GRACE score for in-hospital deaths, the SYNTAX score was 14.2 ± 10.1 in the low-risk group, 16.0 ± 13.4 in the intermediators group, and 24 ± 12.2 in high-risk group (ANOVA p<0.0001). Post-hoc Tukey analysis showed that the high-risk group had a significantly higher SYNTAX score than the low-risk and intermediate risk groups (p<0.0001 vs p=0.003 respectively). There were significant positive correlations between the SYNTAX score and GRACE scores of the study population calculated at admission for in-hospital deaths (r=0.363, p<0.0001). GRACE score can predict complexity of CAD (high risk coronary anatomy). As we can decide to perform early invasive strategy according to GRACE score, we may consider detecting high risk complex coronary anatomy during coronary angiography. So, we may be ready to discuss with heart team about treatment strategy (ad hoc-PCI, multi-vessel PCI or CABG) in patients with high GRACE score. Before giving ADP receptor antagonist, we may consider CABG requirement in these patient population.