Non-ST-elevation acute coronary syndromes in octogenarians: applicability of the GRACE and CRUSADE scores

Area of Science:

• Cardiology
• Geriatric Medicine
• Clinical Risk Stratification

Background:

• Assessing ischemic and bleeding risk is crucial for elderly patients with acute coronary syndromes (ACS).
• Risk assessment in octogenarians with ACS remains understudied.
• Non-ST-elevation acute coronary syndrome (NSTE-ACS) management requires validated risk prediction tools.

Purpose of the Study:

• Evaluate the GRACE and CRUSADE scores' applicability in patients aged 80 years and above with NSTE-ACS.
• Identify key predictors of in-hospital mortality and major bleeding in this elderly cohort.
• Compare the performance of existing scores against novel prediction models.

Main Methods:

• Analysis of 544 patients aged ≥80 years with NSTE-ACS from the Portuguese Registry on Acute Coronary Syndromes.
• Development of prediction models for in-hospital mortality and major bleeding.
• Comparison of GRACE and CRUSADE scores' diagnostic accuracy (AUC) with developed models.

Main Results:

• Coronary angiography use was linked to lower in-hospital mortality risk without increasing major bleeding.
• Major bleeding independently predicted in-hospital mortality and was associated with comorbidities and medications.
• GRACE score demonstrated good accuracy for mortality (AUC 0.75); CRUSADE score showed poor discrimination for bleeding (AUC 0.51).
• Developed prediction model showed moderate accuracy for bleeding (AUC 0.68).

Conclusions:

• The GRACE score is suitable for assessing in-hospital mortality risk in octogenarians with NSTE-ACS.
• The CRUSADE score is inadequate for predicting major bleeding in this age group.
• Novel risk prediction scores are necessary for evaluating bleeding risk in elderly NSTE-ACS patients.