Coronary angiographic profile in non ST elevation acute coronary syndrome: risk stratification and management strategy

Type of funding sources: None.

It has been reported that risk scores like GRACE and TIMI scores in NSTE-ACS are associated with more complex coronary anatomy and predict worse outcomes. No data from Iraq regarding how these scores reflect severity of coronary obstruction.

We aimed to investigate how obstructive coronary lesions are related to GRACE or TIMI risk class in NSTE-ACS.

Patients with NSTE-ACS were prospectively recruited and stratified according to TIMI and GRACE risk scores into high, intermediate and low classes. Their coronary angiography findings were recorded, and results classified accordingly into: Normal coronaries, non-critical coronary lesion<70% and critical coronary lesion (obstruction≥70% of coronary artery).

n=150, among whom 65.33% were referred for coronary catheterization. For patients catheterized within 2 hours: 20% have normal coronary angiography (all in lower risk category), 80 % have obstructive coronary lesions. Moreover, those who were catheterized within>24 hours were 74 patients, among whom; 16.21 % had normal coronary angiography and 81.08% had obstructive (Critical) coronary lesions. However, there was no statistical significance for types of coronary lesions considering timing to intervention or risk category. In 29.59% of those who were referred for catheterization, they had PCI at same session and 29.59% had been referred for CABG. Patients with higher GRACE scores were more frequent to be referred for CABG. Conversely, on classifying patients according to TIMI score, those with intermediate TIMI scores were more to be referred for CABG.

Higher TIMI and GRACE scores were associated with more significant angiographic coronary lesions and with more referral for CABG than lower risk patients. This finding supports the importance of referring higher risk patients for catheterization according to guideline recommendation especially in resource-limited settings in Iraq where proper risk stratification is crucial to choose those who will benefit the most from invasive strategy.