Related Experiment Video
Updated: Feb 2, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk
João Filipe Carvalho1, Adriana Belo2, Kisa Congo1
1Cardiology Department, Hospital do Espírito Santo de Évora, Évora, Portugal.
Insights
A low GRACE score may misclassify severe coronary artery disease. In non-ST-elevation myocardial infarction (NSTEMI) patients, left main and/or three-vessel disease (LM/3VD) was found in 18.2%, predicting higher one-year mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- The GRACE score is used to assess cardiac event risk in acute myocardial infarction (AMI).
- A low GRACE score may underestimate severe coronary artery disease, including left main and/or three-vessel disease (LM/3VD).
- Accurate risk stratification is crucial for optimal management of non-ST-elevation acute myocardial infarction (NSTEMI) patients.
Purpose of the Study:
- To determine the prevalence of LM/3VD in NSTEMI patients with a low GRACE score (≤108).
- To investigate the clinical outcomes, including in-hospital complications and one-year mortality, associated with LM/3VD in this patient group.
- To identify independent predictors of LM/3VD in NSTEMI patients with a low GRACE score.
Main Methods:
- Retrospective analysis of 1196 NSTEMI patients from the Portuguese Registry on Acute Coronary Syndromes with a GRACE score ≤108.
- Coronary angiography data was used to identify LM/3VD.
- Statistical analysis was performed to determine predictors and outcomes, including in-hospital complications and one-year mortality.
Main Results:
- LM/3VD was present in 18.2% of NSTEMI patients with a GRACE score ≤108.
- Prevalence of LM/3VD was higher in males and associated with hypertension, diabetes, heart failure, and peripheral arterial disease (PAD).
- Patients with LM/3VD had similar in-hospital complications but significantly higher one-year mortality (2.4% vs. 0.5%, p=0.005).
- Independent predictors of LM/3VD included age, male gender, heart rate, PAD, and heart failure.
Conclusions:
- LM/3VD is prevalent in NSTEMI patients with a low GRACE score, affecting approximately one in five individuals.
- These patients face a higher risk of one-year mortality despite similar in-hospital complication rates.
- Simple clinical variables can effectively predict the presence of severe coronary anatomy (LM/3VD) in this population.
Introduction:
A low-risk GRACE score identifies patients with a lower incidence of major cardiac events, however it can erroneously classify patients with severe coronary artery disease as low-risk. We assessed the prevalence, clinical outcomes and predictors of left main and/or three-vessel disease (LM/3VD) in non-ST-elevation acute myocardial infarction (NSTEMI) patients with a GRACE score of ≤108 at admission.
Methods:
Using data from the Portuguese Registry on Acute Coronary Syndromes, 1196 patients with NSTEMI and a GRACE score of ≤108 who underwent coronary angiography were studied. Independent predictors of LM/3VD and its impact on in-hospital complications and one-year mortality were retrospectively analyzed.
Results:
LM/3VD was present in 18.2% of patients. Its prevalence was higher in males and associated with hypertension, diabetes, previous myocardial infarction, heart failure and peripheral arterial disease (PAD). Although there were no differences in in-hospital complications, these patients had higher mortality (0.9 vs. 0.0%) and more major adverse cardiac and cerebrovascular events (MACCE) (4.1 vs. 2.5%, p=0.172), and higher one-year mortality (2.4 vs. 0.5%, p=0.005). Independent predictors of LM/3VD were age (OR 1.03; 95% CI 1.01-1.0, p=0.003), male gender (OR 2.56; 95% CI 1.56-4.17, p<0.001), heart rate (1.02; 95% CI 1.01-1.03, p<0.001), PAD (OR 3.21; 95% CI 1.47-7.00, p<0.001) and heart failure (OR 3.38; 95% CI 1.02-11.15, p=0.046).
Conclusions:
LM/3VD was found in one in five patients. These patients had a tendency for higher in-hospital mortality and more MACCE, and higher one-year mortality. Simple clinical variables could help predict this severe coronary anatomy.
Related Concept Videos
01:08Prevalence and Incidence
Prevalence indicates the proportion of individuals in a population who have a specific disease or health...
03:12Freezing Point Depression and Boiling Point Elevation
The boiling point of a liquid is the temperature at which its vapor pressure is equal to ambient atmospheric pressure. Since the vapor pressure of a solution is lowered due to the presence of nonvolatile solutes, it stands to reason that the solution’s boiling point will subsequently be increased. Vapor pressure increases with temperature, and so a solution will require a higher temperature than will pure solvent to achieve any given vapor pressure, including one...
01:24Chronic Kidney Disease II: Clinical Manifestations
01:06Introduction to z Scores
z scores...
01:05Introduction to z Scores
z scores...
01:17z Scores and Area Under the Curve