Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10143-10150
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10143
Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome
Xiao-Feng Wang, Ming Zhao, Fei Liu, Guo-Rong Sun
Xiao-Feng Wang, Ming Zhao, Fei Liu, Guo-Rong Sun, Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
Author contributions: Wang XF, Zhao M, Fei Liu F, and Sun GR contributed to the manuscript writing, revising; All authors confirmed the revised version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Cangzhou Central Hospital Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Feng Wang, MSc, Doctor, Department of Cardiology, Cangzhou Central Hospital, No. 16 West Xinhua Road, Yunhe District, Cangzhou 061000, Hebei Province, China. dahuanhuan888@163.com
Received: July 6, 2021
Peer-review started: July 6, 2021
First decision: July 26, 2021
Revised: August 9, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: November 26, 2021
Processing time: 139 Days and 1.5 Hours
Abstract
BACKGROUND

GRACE and SYNTAX scores are important tools to assess prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, there have been few studies on their value in patients receiving different types of therapies.

AIM

To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.

METHODS

The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups. A total of 195 patients who received agents alone comprised the medication group, 156 who received medical therapy combined with stents comprised the stent group, and 35 patients who were given agents and underwent coronary artery bypass grafting (CABG) comprised the CABG group. General information was compared among the three groups. GRACE and SYNTAX scores were calculated. The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events (MACEs) was analyzed. Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS. Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.

RESULTS

The incidence of MACE increased with the elevation of GRACE and SYNTAX scores (all P < 0.05). The incidence of MACE was 18.5%, 36.5%, and 42.9% in the medication group, stent group, and CABG group, respectively. By comparison, the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups (all P < 0.05). The incidence of MACE was 6.2%, 28.0% and 40.0% in patients with a low GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 31.0%, 30.3% and 42.9% in patients with a medium GRACE score in the medication group, stent group, and CABG group, respectively (P > 0.05). The incidence of MACE was 16.9%, 46.2%, and 43.8% in patients with a high GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 16.2%, 35.4% and 60.0% in patients with a low SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 37.5%, 40.9%, and 41.7% in patients with a medium SYNTAX score in the medication group, stent group, and CABG group, respectively (P > 0.05). MACE incidence was 50.0%, 75.0%, and 25.0% in patients with a high SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). Univariate Cox regression analyses showed that both GRACE score (hazard ratio [HR] = 1.212, 95% confidence interval [CI]: 1.083 to 1.176; P < 0.05) and SYNTAX score (HR = 1.160, 95%CI: 1.104 to 1.192; P < 0.05) were factors influencing MACE (all P < 0.05). Multivariate Cox regression analyses showed that GRACE (HR = 1.091, 95%CI: 1.015 to 1.037; P < 0.05) and SYNTAX scores (HR = 1.031, 95%CI: 1.076 to 1.143; P < 0.05) were independent predictors of MACE (all P < 0.05).

CONCLUSION

GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients, and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.

Keywords: GRACE score; SYNTAX score; Non-ST elevation acute coronary syndrome; Prognosis

Core Tip: Risk stratification with a specific risk score can provide an estimate of patient prognosis and optimize clinical strategies. This study discussed the capabilities of GRACE and SYNTAX score in predicting the incidence of different major adverse cardiovascular events (MACEs) in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). It showed that the incidence of MACE was lower in patients with low and high GRACE and SYNTAX scores who received agents than in patients who underwent stent placement or coronary artery bypass grafting. These data suggest that GRACE and SYNTAX scores have prognostic value in NSTE-ACS patients.