Impact of Coronary Artery Disease Extent on GRACE Risk Score Prognostic Performance After ST-Segment-Elevation...

Area of Science:

• Cardiology
• Clinical Risk Stratification
• Acute Coronary Syndromes

Background:

• The GRACE score is validated for non-ST-segment-elevation myocardial infarction but less established for ST-segment-elevation myocardial infarction (STEMI).
• Prognostic performance of the GRACE score in STEMI, considering coronary disease extent, requires further evaluation.

Purpose of the Study:

• To assess the prognostic performance of the GRACE score in a STEMI cohort.
• To evaluate the GRACE score's utility relative to coronary disease burden in STEMI patients.

Main Methods:

• A cohort of 1099 STEMI patients from the CardioLines Coronary Biobank (2015-2021) with evaluable GRACE scores and follow-up data was analyzed.
• Patients were stratified by the number of coronary vessels with significant stenosis.
• Primary endpoint: 1-year all-cause death. Secondary endpoint: 1-year composite of death, recurrent ACS, stroke, or revascularization.

Main Results:

• GRACE scores positively correlated with the number of diseased vessels (P<0.001).
• Each 10-point GRACE score increase correlated with higher 1-year risks: 31% for all-cause death and 14% for the composite endpoint.
• Discrimination for all-cause death was excellent early in single-vessel disease (AUC 0.874 at 30 days) but poor in 3-vessel disease (AUC 0.52-0.57).
• Discrimination was significantly better in single-vessel versus multivessel disease early on, with differences diminishing by 1 year.

Conclusions:

• The GRACE score effectively stratifies risk in STEMI patients with single-vessel disease.
• The GRACE score demonstrates poor prognostic performance in STEMI patients with multivessel disease.
• Prognostic utility of the GRACE score varies with coronary anatomic burden post-STEMI, necessitating caution in its application across different STEMI subgroups.