Sensitivity, specificity, positive and negative likelihood ratios and positive and negative predictive values were also described. The predictive accuracy of risk scores concerning the presence of CAD or severe anatomy was tested with the receiver-operating characteristics (ROC) curve. The Kruskal-Wallis test was used to compare score values between the groups divided according to GRACE tertiles. Linear regression was used to demonstrate the influence of GRACE score in coronary disease extent. The association of GRACE with anatomical severity was assessed by Spearman’s and Pearson’s correlation tests, according to normal distribution of the scores. Lastly, SYNTAX 14 score, which assesses each coronary with a diameter ≥ 1.5 mm and obstruction ≥ 50% following a previously described tutorial 14, considering angiographic parameters such as location of lesion and number of affected vessels, presence of bifurcation lesion in coronary ostia, total artery occlusion, time of occlusion, collateral circulation, lesion extent, presence of thrombi, significant tortuosity, excessive calcification and diffuse disease. Establishing two points for each segment, the total can vary from 0 to 12 points. Gensini score 8 assesses 28 coronary segments, according to CASS map 9, 10, which is scored according to their anatomical relevance (ranging from 0.5 to 5) multiplied by a factor relating to maximum obstruction degree in diameter (0 - 25% = 2 26% - 50% = 4 51% −75% = 8 76% - 90% = 16 91% - 99% = 32 100% = 64 points).įriesinger score 11 uses a simpler sum of 0 to 15, from three main coronary arteries being quantified from 0 to 5 (0 - without angiographic abnormalities 1 - diameter irregularities with obstruction 75% obstruction in diameter, using a previously described 13 six-segment coronary grading system to estimate myocardial mass at risk. Severe anatomical disease was defined as obstructive involvement (≥ 70% in diameter) in (1) left main coronary artery or (2) double or triple vessel disease involving proximal left anterior descending artery or (3) obstruction ≥ 95% in any proximal arterial segment.Īll patients underwent a coronary anatomy analysis by an experienced interventional cardiologist, blind to treatment modality and clinical condition, who measured the number of vascular territories, categorized severe anatomy and quantified coronary disease extent by using different angiographic scores: modified Gensini, Friesinger, proximal disease score, Duke Jeopardy and SYNTAX. Obstructive coronary artery disease was defined as stenosis ≥ 70% in any epicardial coronary artery or obstruction ≥ 50% in left main coronary artery. The protocol is in accordance with the Declaration of Helsinki 7, was approved by the Institution’s Research Ethics Committee and all evaluated patients signed informed consent forms. Exclusion criteria were previous revascularization surgery or a patient’s refusal to participate in study. For the present analysis, only patients who underwent invasive coronary angiography during hospitalization were selected.

The criteria for inclusion was defined as typical chest discomfort at rest in the last 48 hours, associated with at least one of the following: positive myocardial necrosis marker, defined by troponin T ≥ 0.01 µg/L or troponin I > 0.034 µg/L, which correspond to values above the 99 percentile 5, 6, ischemic electrocardiographic changes, consisting in T wave inversion (≥ 0.1 mV) or transient ST segment depression (≥ 0.05 mV) or coronary artery disease previously documented, defined by a myocardial infarction history or previous angiography showing coronary obstruction ≥ 50%. There was a weak correlation between GRACE and anatomical scores such as SYNTAX (r = 0.36, P < 0.001) and Gensini (r = 0.36, P < 0.001).Īll patients admitted to the coronary care unit with a diagnosis of ACS from July 2007 to December 2017 were included in a Registry of Acute Coronary Syndromes. This standard definition of intermediate-high risk by the GRACE score (> 109) revealed sensitivity of 67% in detecting severe anatomy (95% CI = 61% - 72%) and specificity of 50% (95% CI = 46% - 55%), resulting in positive likelihood ratio of 1.3 (95% CI = 1.2 - 1.5) and negative likelihood ratio of 0.66 (95% CI = 0.55 - 0.80). The cutoff point below which the first GRACE tertile is defined (109) was used to dichotomize low-risk (N = 318) and medium-high-risk (N = 415) samples. The area under the ROC curve of the GRACE score was 0.65 (95% CI = 0.61 - 0.69) for predicting severe disease. Obstructive coronary disease was observed in 81% of the patients, classified as one, two or three vessel disease, or left main coronary artery involvement in 28%, 23%, 26% and 4%, respectively. Results A total of 733 patients were evaluated, aged 63 ± 14 years, 61% male and GRACE score of 119 ± 37.

Grace vs timi score