DOES GRACE SCORE INCREMENT PROGNOSTIC ASSESSMENT AFTER ANGIOGRAPHY IN ACUTE CORONARY SYNDROMES?

Resumo

Rational: The GRACE Score assessed at admission predicts mortality in patients with non-ST elevation acute coronary syndromes (ACS). However, once coronary anatomy is assessed, it is not known whether this score increments prognostic assessment.  Objective: To test the hypothesis that the GRACE Score adds prognostic value to coronary anatomy in patients with ACS. Methods: Prospective cohort, including patients with ACS who underwent coronary angiography while admitted to the hospital. Anatomical extension of coronary disease was characterized by the Duke Jeopardy score (DJS) and the number diseased artery (NDA). The primary end-point was the composite of death, non-fatal MI or refractory unstable angina.  Results: 112 patients enrolled, aged 70 ± 12, 14% incidence of cardiovascular events. C-statistics for GRACE was 0.68 (95%CI=0.53-0.84), for DJS was 0.78 (95%CI=0.67-0.9) and for NAD was 0.74 (95%CI=0.61-0.88). Logistic regression analysis demonstrated independent predictive value of GRACE in relation to anatomical information. However, when this Score was added to DJS or NDA, no improving in c-statistic was observed: DJS-GRACE had a c-statistics of 0.78 (95%CI=0.64–0.92) and NAD-GRACE of 0.76 (95%CI=0.60–0.92).  Conclusion: The GRACE score does not add prognostic value to angiographic data in patients with ACS.