Cor Vasa 2014, 56(4):e333-e336 | DOI: 10.1016/j.crvasa.2014.04.002

The magnitude of percutaneous coronary intervention treatment in high and medium risk non-ST elevation acute coronary syndrome

David Becker^*, Anna Móri, Gyorgy Bárczi, Hajnalka Vágó, Orsolya Szenczi, Balazs Berta, Krisztina Heltai, Endre Zima, Pal Maurovich-H., Bela Merkely

Semmelweis University Heart and Vascular Center, Budapest, Hungary

Introduction: Current ESC guideline supported invasive treatment of non-ST elevation acute coronary syndrome (NSTE-ACS) is guided by GRACE risk model.

Objective: The aim of this study was to determine whether the percutaneous coronary intervention treatment in NSTE-ACS ameliorates the long-term mortality assessed by GRACE risk score.

Methods: We conducted a retrospective study of a consecutive sample of 680 patients with NSTE-ACS treated by PCI in Heart Center of Semmelweis University. The GRACE risk score was calculated for each patient at admission. The mean of relative risk in each group was assessed and compared with the long-term clinical outcomes (observed 6-month mortality).

Results: The mean of calculated GRACE amounts 1.6% for low risk patients, 5.0% for medium risk patients, and 21.3% for patients with high risk. In contrast, the observed risk of 6-month death was 0.42% for low risk patients, 1.1% for medium risk patients, and 12.6% for patients with high risk.
Difference between assessed and observed 6-month mortality in high risk and medium risk groups was significant (medium risk p = 0.004; high risk p = 0.0097). Observed risk of death in low risk patients was also lower, but not significant than assessed risk.

Conclusion: The risk of death in patients with NSTE-ACS treated in high volume center is significantly lower than predicted by GRACE risk model. Our results suggest that percutaneous coronary intervention treatment guided by GRACE risk model in medium and high risk patents with NSTE-ACS provides the greatest clinical benefit.

Keywords: Acute coronary syndrome; GRACE; Percutaneous coronary intervention

Received: February 27, 2014; Revised: April 6, 2014; Accepted: April 8, 2014; Published: August 1, 2014  Show citation