![]() ![]() ![]() Patients without typical symptoms and serial negative biomarkers of necrosis are diagnosed as UA. NSTEMI is defined by Electrocardiography (ECG) ST-segment depression or prominent T-wave inversion with positive biomarkers of necrosis in the absence of persistent (<20 min) ST-segment elevation. Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) constitutes a clinical syndrome subset of the acute coronary syndrome (ACS) that is usually, but not always, caused by atherosclerotic CAD and is associated with an increased risk of cardiac death and subsequent myocardial infarction. Ischemic heart disease contributed to 17.8% of total deaths and 8.7% of total disability-adjusted life years in India. Among these, coronary artery disease (CAD) is the most common and is associated with high rate of mortality and morbidity. Conclusions: Both the GRACE and TIMI risk scores were a good predictor of angiographic severity of CAD in patients with NSTE-ACS, and the GRACE score was found to be superior to the TIMI risk score.Ĭardiovascular diseases are currently the leading cause of mortality and morbidity in industrialized countries. Risk factors such as higher age, hypertension, smoking history, dyslipidemia, ECG changes such as ST deviation and T inversion, and Killip classification showed a statistically significant association with severity of disease. The area under the ROC curve for the GRACE score was 0.765 (95% confidence interval = 0.676-0.854), significantly superior to the area under the ROC curve of the TIMI score (0.715 95% CI = 0.618-0.812). Results: A positive association between the Gensini score and vessel score was observed with both the GRACE (P = 0.001) and TIMI (P = 0.001) scores. The receiver operating characteristic (ROC) curve was applied for the predictability of GRACE and TIMI scores for severity of disease. For comparison of two means, independent sample t-test/Mann-Whitney U-test was used, while for more than two means, one-way ANOVA/Kruskal-Wallis test was used. Statistical Analysis Used: SPSS software version 27.0 was used for statistical analysis. Coronary angiogram was done and the Gensini score and vessel score were used to assess the severity of CAD. The GRACE and TIMI scores were estimated. Subjects and Methods: Total 202 NSTE-ACS (NSTE myocardial infarction and unstable angina) patients were included. Settings and Design: This was an observational cross-sectional study. Aims: We aimed to compare the GRACE score with TIMI risk score for prediction of the angiographic severity of coronary artery disease (CAD) in patients with NSTE-ACS. SatapathyĬontext: The Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in predicting coronary disease severity in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) have not been proved. In addition, angiography with possible percutaneous coronary intervention of "culprit" lesions should always be used in combination with aggressive medical therapy to treat the widespread coronary atherosclerosis commonly seen in patients with ACS.Byline: Satyanarayan. In spite of the benefits of this synergistic combination of pharmacology and mechanical revascularization, risk stratification remains important in identifying high-risk individuals most likely to benefit from an "early invasive" approach. Perhaps more importantly, the combined use of glycoprotein IIb/IIIa inhibitors and intracoronary stenting may reduce the potential early hazard of an invasive approach by specifically decreasing the incidence of death and nonfatal myocardial infarction associated with percutaneous intervention. In particular, use of glycoprotein IIb/IIIa inhibitors and/or low-molecular-weight heparin before catheterization have been shown to reduce clinical events in patients with ACS, and may reduce the risk of an invasive approach by plaque passivation before interventional therapy. Improved clinical outcomes associated with an "early invasive" strategy may have evolved as a consequence of recent advances in both adjunctive pharmacotherapy and revascularization technique. More recent studies, however, have demonstrated improved clinical outcomes with the use of an "early invasive" approach, employing routine coronary angiography early in the patient's hospital course, followed by percutaneous intervention or bypass surgery where appropriate. In this approach, diagnostic cardiac catheterization and revascularization are only used in patients with objective evidence of myocardial ischemia as identified by recurrent symptoms or provocative stress testing. Conventional therapy for non-ST-segment elevation acute coronary syndrome (ACS) has traditionally employed an "ischemia-guided" strategy. ![]()
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