Vol. 6, Issue 2, Part A (2024)

Background: The prediction of obstructive coronary artery disease (CAD) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is crucial for risk stratification and treatment planning. This study evaluates the utility of the GRACE risk score and coronary artery calcium (CAC) score, individually and combined, as predictors of obstructive CAD in NSTE-ACS patients.
Methods: This comparative study included 202 NSTE-ACS patients scheduled for coronary angiography (CAG). The GRACE score was calculated, and CAC scoring was performed using a 128-slice CT scanner. CAG assessed the presence and extent of obstructive CAD. 
Results: Patients with obstructive CAD had significantly higher median GRACE (108 vs. 83.5, p< 0.001) and CAC scores (183.6 vs. 1.5, p< 0.001). A CAC score of zero had an 84.8% negative predictive value for excluding significant stenosis. The combination of GRACE and CAC scores enhanced predictive specificity for obstructive CAD (AUC 0.891), showing a sensitivity of 69.67% and specificity of 95.00%.
Conclusion: The CAC and GRACE scores are reliable predictors of obstructive CAD in NSTE-ACS patients. Combining these scores improves risk stratification, potentially influencing clinical decision-making and patient outcomes.