The Global Registry of Acute Coronary Events (GRACE) score is a widely recognized tool for predicting adverse cardiovascular events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The triglyceride-glucose index (TyG index) is a new biomarker of insulin resistance and has a close association with the occurrence of adverse cardiovascular events. We investigated whether the addition of the TyG index to the GRACE score could improve prognosis prediction in patients with NSTE-ACS undergoing percutaneous coronary intervention (PCI).

In total, 515 patients with NSTE-ACS undergoing PCI were included in this retrospective study. Kaplan-Meier analysis was performed to describe the cumulative incidence of the primary endpoint based on the median TyG index. The relationship between the TyG index and GRACE score was analyzed using Spearman's rank correlation. Univariate and multivariate Cox proportional hazards analyses were used to identify independent risk factors. Based on the receiver operating characteristic curve, net reclassification improvement (NRI), integrated differentiation improvement (IDI), and decision curve analysis, the TyG index was evaluated for its predictive value when added to the GRACE score. ROC curve analyses, NRI, and IDI were used to compare the gain effect of the TyG index and the levels of HbA1C, FBG, TG, and LDL-C on the GRACE score for predicting adverse cardiovascular events.

The TyG index was an independent predictor of 2-year adverse cardiovascular events in patients with NSTE-ACS undergoing PCI. The addition of the TyG index to the GRACE score demonstrated an improved ability to predict 2-year adverse cardiovascular events compared with the GRACE score alone (AUCs: GRACE score 0.798 vs. GRACE score+TyG index 0.849, P = 0.043; NRI = 0.718, P < 0.001; IDI = 0.086, P < 0.001). The decision curve analysis suggested that the clinical net benefit of the new model (GRACE score+TyG index) was superior to that of the GRACE score alone, with a probability range of 0.04 to 0.32. When including the TyG index, HbA1C, FBG, TG, and LDL-C in the GRACE score system, we found that the TyG index had a greater incremental impact on risk prediction and stratification compared to the other parameters.

Combining the TyG index and GRACE score could improve the prediction of 2-year adverse cardiovascular events. This new risk model could identify patients with NSTE-ACS at higher risk of adverse events following PCI so that they can be monitored more carefully.

• Science and Technology Department of Henan Province

Bleedings are an independent risk factor for subsequent mortality in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention. This represents a hazard equivalent to or greater than that for recurrent ACS. Dual antiplatelet therapy (DAPT) represents the cornerstone in the secondary prevention of thrombotic events, but the benefit of such therapy is counteracted by the increased hemorrhagic complications. Therefore, an early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients.

To review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease (IHD).

We used a combination of terms potentially used in literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed as well as references of full-length articles.

In this review we briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD, focusing on GRACE, CHA2DS2-Vasc, PARIS CTE, DAPT, CRUSADE, ACUITY, HAS-BLED, PARIS MB and PRECISE-DAPT score. In the second part of this review, we try to define a possible approach to the IHD patient, using the most suitable scores to stratify patient risk and decide the most appropriate patient treatment.

It becomes evident that risk scores by themselves can’t be the solution to balance the ischemic/bleeding risk of an IHD patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.

• Acute coronary syndrome
• Ischemic heart disease
• Risk score
• Bleeding
• Mortality
• Percutaneous coronary intervention

• All-treatment strategies
• Non-ST-elevation acute coronary syndrome
• Risk scores

• Acute Coronary Syndrome/diagnostic imaging
• Acute Coronary Syndrome/mortality
• Acute Coronary Syndrome/therapy
• Aged
• Clinical Decision-Making
• Coronary Angiography
• Coronary Artery Bypass
• Decision Support Techniques
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction/diagnostic imaging
• Non-ST Elevated Myocardial Infarction/mortality
• Non-ST Elevated Myocardial Infarction/therapy
• Percutaneous Coronary Intervention
• Predictive Value of Tests
• Prospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome