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

Abstract

Background: Coronary artery disease (CAD) severity in acute coronary syndrome (ACS) can be evaluated using various scoring systems.  The Global Registry of Acute Coronary Events (GRACE) score and the SYNergy between percutaneous coronary intervention with TAXus  and cardiac surgery (SYNTAX) score are essential tools for risk stratification and determining CAD complexity.

Objective: To evaluate the  correlation between the GRACE score and the severity of CAD assessed by the SYNTAX score in patients with unstable angina/non-ST  elevation myocardial infarction (UA/NSTEMI).

Patients and Methods: This cross-sectional observational study included 109 adult patients  with ACS who underwent coronary angiography (CA) at 6th October Insurance Hospital and Benha University Hospital between  October 2022 and October 2023. The GRACE score was calculated using clinical parameters and the SYNTAX score assessed coronary  lesion complexity.

Results: A significant correlation was found between the GRACE and SYNTAX scores (r=0.603, p<0.05). Patients with a SYNTAX score ≥23 had significantly higher GRACE scores (median ± Interquartile range (IR) 119 ± 18) compared to those with a SYNTAX  score <23 (median ± IR 96 ± 31) (p<0.001). ROC analysis revealed an AUC of 0.844 (95% CI, 0.768–0.919) for the GRACE score predicting a  SYNTAX score ≥23, with a sensitivity of 80.3% and specificity of 75% at a cut-off value of 109.

Conclusion: The GRACE score is a reliable  predictor of CAD severity as assessed by the SYNTAX score in patients with UA/NSTEMI. This correlation supports using the GRACE score  for initial risk stratification and management planning in this patient population.