Can GRACE Risk Score Predict the in-hospital Symtomatic Heart Failure Development After Myocardial Infarction Without ST Segment Elevation?

Objective: The Global Registry of Acute Coronary Events (GRACE) risk score has a prognostic significance in patients with myocardial infarction without ST segment elevation (NSTEMI). In this study, we aimed to evaluate the significance of GRACE score at day 1 in predicting the development of in-hospital symptomatic heart failure (IH-HF) in patients presenting with NSTEMI. Material and Methods: Consecutive patients, admitted with NSTEMI between April 2016-May 2017 were evaluated in this prospective cohort study. A total of 179 patients (112 male, the mean age: 65.4±11.2) with left ventricular ejection fraction (LV-EF) <50% and N-terminal pro Btype natriuretic peptide (NT-proBNP) level >125pg/mL along with Killip Class <II symptoms at admission were included in the study. GRACE score at day 1 was calculated according to original scoring system. During hospitalization period, patients who developed Killip Class (KC) ≥2 symptoms after day 1 to discharge were classified as IH-HF (n=55) and others were classified as NIH-HF (n=124). Results: The morbidity and mortality rates were higher in the IH-HF group. Not only GRACE score at day 1 but also atrial fibrillation (AF), three vessel disease, diabetes mellitus (DM) were found to be independent predictors of IH-HF. According to the ROC analysis, the patients with GRACE score at day 1 > 177.5 were found to be at higher risk for IH-HF development. Conclusion: The development of IH-HF in patients presenting with NSTEMI with asymptomatic left ventricular dysfunction significantly increases the morbidity and mortality rates. High GRACE score at day 1 in NSTEMI patients can be used to predict IH-HF. [ABSTRACT FROM AUTHOR]