Correlation of In-Hospital Grace Risk Score with Severity of Coronary Artery Disease by Syntax Score in Patients with Non-St Segment Elevation Myocardial Infarction (NSTEMI)
DOI:
https://doi.org/10.65761/pjcr.2026.289Keywords:
NSTEMI; GRACE score; SYNTAX score; coronary artery disease; risk stratification; ROC curve; angiographic complexity.Abstract
Background: The GRACE score predicts NSTEMI risk, while the SYNTAX score assesses coronary complexity. This study evaluated their association in NSTEMI patients.
Methods: This prospective observational diagnostic-correlation cohort included 120 consecutive adults with NSTEMI undergoing coronary angiography within 48 hours at a tertiary cardiac center in Pakistan. GRACE scores were calculated at admission, while two interventional cardiologists independently assessed SYNTAX scores. Pearson correlation, ROC analysis, and multivariable logistic regression evaluated associations and discrimination for SYNTAX ≥23 and ≥33. SYNTAX inter-rater reliability was assessed using ICC and Bland-Altman analysis.
Results: The mean age was 60.9 ± 10.6 years, and 91 (75.8%) participants were male. The GRACE score demonstrated a strong positive correlation with the SYNTAX score (r = 0.781, 95% CI 0.699-0.842; p < 0.001). ROC analysis showed excellent discrimination for SYNTAX ≥23 (area under the curve [AUC] 0.890, 95% CI 0.828-0.952; p < 0.001), with an optimal GRACE cutoff of 107 yielding 83.2% sensitivity and 84.2% specificity. For SYNTAX ≥33, the AUC was 0.798 (95% CI 0.716-0.879; p < 0.001), with an optimal GRACE cutoff of 126, providing 69.6% sensitivity and 81.3% specificity. After multivariable adjustment, each 10-point increase in GRACE score was independently associated with higher odds of SYNTAX ≥23 (adjusted odds ratio [aOR] 2.88, 95% CI 1.57-5.29; p < 0.001) and SYNTAX ≥33 (aOR 1.86, 95% CI 1.38-2.50; p < 0.001). Inter-rater agreement for SYNTAX scoring was excellent (ICC 0.933, 95% CI 0.905-0.952).
Conclusion: In NSTEMI patients, higher GRACE scores were associated with greater coronary complexity and effectively identified SYNTAX ≥23, supporting pre-angiographic risk stratification, pending external validation.
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Copyright (c) 2026 Tariq Saleem, Asifa Aslam, Muhammad Ahsan Fareed, Maham Riaz, Muhammad Ayaz Arshad, Muhammad Sultan Bashir, Momina Arshad
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