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

Our results showed a positive correlation between GRACE score and angiographic SYNTAX score. GRACE score had a significant but modest capacity to predict the severity and its high negative predictive value could help to speculate that a patient may have normal or mild CAD prior to coronary angiography. It may also assist the cardiologist to stratify the patients' risk and decide on the choice of revascularization strategy. Nonetheless, our results need to be validated by larger studies in the future.

I recently published a paper in Cardiovascular Revasculariation Journal that discusses the accuracy of the GRACE score in predicting the severity and extent of coronary artery stenosis by SYNTAX score in patients with unstable angina or NSTEMI.

In this study that included 330 acute coronary symptoms who presented to Imam Khomeini Hospital in Tehran, and underwent coronary angiography, we used the SYNTAX scoring system to evaluate the severity and extent of coronary stenotic lesions and the GRACE score (used for risk stratification and assessing the prognosis of patients with ACS).

Based on our results, patients categorized under the SYNTAX score ≥ 23 tended to be older, more male and had a higher GRACE score as compared with the other group. Smoking and diabetes mellitus (DM) were also more frequent in these patients.

A positive correlation was observed between GRACE score and angiographic SYNTAX score (r = 0.34 p < 0.001).

By ROC analysis, GRACE score predicted SYNTAX score ≥ 23 with an area under ROC of 0.678 (CI 0.581%–0.775%, p < 0.001). A GRACE score of 109 was identified as the optimal cut-off to predict SYNTAX score ≥ 23 with a sensitivity of 73.5% and specificity of 60%. The positive predictive value was 20.5% while the negative predictive value was 94.0%. The positive and negative likelihood ratios were 1.83 and 0.45, respectively. Diagnostic accuracy of GRACE score for predicting SYNTAX score ≥ 23 was 61.5%.

We believe that GRACE score has a modest capacity to predict the severityof CAD and its high negative predictive value could help to rule out patients who do not need coronary angiography. It may also assist the cardiologist to stratify the patients’ risk and decide on the choice of revascularization strategy. However, further investigation is warrented.

Read the full text here.

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