The magnitude of percutaneous coronary intervention treatment in high and medium risk non-ST elevation acute coronary syndrome

IntroductionCurrent ESC guideline supported invasive treatment of non-ST elevation acute coronary syndrome (NSTE-ACS) is guided by GRACE risk model.ObjectiveThe aim of this study was to determine whether the percutaneous coronary intervention treatment in (NSTE-ACS) ameliorates the long-term mortality assessed by GRACE risk score.MethodsWe conducted a retrospective study of a consecutive sample of 680 patients with (NSTE-ACS) treated by PCI in Heart Center of Semmelweis University. The GRACE risk score was calculated for each patient at admission. The mean of relative risk in each group was assessed and compared with the long-term clinical outcomes (observed 6-month mortality).ResultsThe mean of calculated GRACE amounts to 1.6% for low risk patients, 5.0% for medium risk patients, and 21.3% for patients with high risk. In contrast, the observed risk of 6-month death was 0.42% for low risk patients, 1.1% for medium risk patients, and 12.6% for patients with high risk. The difference between assessed and observed 6-month mortality in high risk and medium risk groups was significant (medium risk p = 0.004; high risk p = 0.0097). Observed risk of death in low risk patients was also lower, but not significant than assessed risk.ConclusionThe risk of death in patients with NSTE-ACS treated in a high volume center is significantly lower than predicted by the GRACE risk model. Our results suggest that percutaneous coronary intervention treatment guided by the GRACE risk model in medium and high risk patents with (NSTE-ACS) provides the greatest clinical benefit.