Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a special type of myocardial infarction (MI). The GRACE risk score is commonly used to predict major adverse cardiovascular events (MACE) in non-ST-elevation myocardial infarction patients, and the suitability of the GRACE risk score for prognostic stratification in patients with MINOCA remains uncertain. This study aimed to investigate whether the GRACE risk score is capable of predicting MACE in MINOCA patients with NSTE. We calculated the GRACE risk score for 340 consecutive MINOCA patients with NSTE. Patients were divided into a low-intermediate risk group (≤ 140, 48.8%) and a high risk group (>140, 51.2%) according to their GRACE risk scores. The clinical characteristics and outcomes of the patients were assessed. Patients in the high risk group tended to be older and to have more comorbidities. At the 1-year follow-up, the rate of cardiac death in the high risk group was significantly higher than that in the low-intermediate-risk group (p = 0.010). There was no significant difference in non-fatal MI, stroke, heart failure, or cardiovascular-related rehospitalization. The incidence of total MACE was significantly higher in patients with high GRACE risk scores than in patients with low GRACE risk scores (p = 0.006). ROC curve analysis showed that the GRACE risk score has moderate value in predicting MACE in NSTE-MINOCA patients. The area under the ROC curve was 0.710 (95% CI 0.625–0.796, P < 0.001). The GRACE risk score provides potentially valuable prognostic information on clinical outcome when applied to MINOCA patients with NSTE.
Highlights
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a puzzling clinical entity that has been increasingly identified by coronary angiography during acute myocardial infarction (MI) and is characterized by clinical evidence of MI with normal or near-normal coronary arteries [1, 2]
Several studies have demonstrated that MINOCA patients have a better prognosis than MI-CAD patients [3, 4]; there are numerous reports that MINOCA has a similar prognosis to MI-CAD [5, 6] and that MINOCA patients have a higher incidence of major adverse cardiovascular events (MACE) than the general population [7, 8]
This study aimed to investigate whether the GRACE risk score is suitable to predict 1-year MACE in MINOCA patients with NSTE (NSTE-MINOCA)
Summary
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a puzzling clinical entity that has been increasingly identified by coronary angiography during acute myocardial infarction (MI) and is characterized by clinical evidence of MI with normal or near-normal coronary arteries [1, 2]. GRACE Risk Score in NSTE-MINOCA on an electrocardiogram (ECG), and patients with NSTE are more prevalent in the MINOCA population than those with STE [1, 3]. The GRACE risk score is commonly used in the prediction of low and high risk of adverse outcomes due to MACE in ACS [11,12,13]. It is the preferred risk score in clinical practice guidelines [13, 14] and considered the gold standard for the initial risk assessment of patients with suspected ACS in clinical settings. The suitability of the GRACE risk score for prognostic stratification in patients with MINOCA remains uncertain
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