Jing-Wen Ma, Shan Muhammad, U Joseph Schoepf, Chuang-Shi Wang, Zhi-Hui Hou, Yun-Qiang An, Er-Li Zhang, Yan Liang, Zhou Zhou, Ya-Hui Lin, Wei-Hua Yin, Bin Lu
The Global Registry of Acute Coronary Events (GRACE) 2.0 risk score has been recommended in guidelines to orient therapeutic strategy and risk assessment for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). To evaluate the incremental value of computed tomography (CT)-based coronary atherosclerosis plaque burden to GRACE 2.0 score in refining the intermediate-term prognostic accuracy and risk stratification for emergency NSTE-ACS. In this prospective cohort study, from January 2017 to January 2021, NSTE-ACS individuals were enrolled and randomly divided into a developing and validation sets by 7:3. We estimated the correlations between GRACE 2.0 score and CT findings. The primary outcomes are the incremental prognostic value of CT for the GRACE 2.0 score's efficacy in predicting 3-year mortality or myocardial infarction (MI). A total of 1248 consecutive NSTE-ACS patients undergoing CT scans were prospectively included. The risk of 3-year mortality or MI was greater in the higher CACS category (HR, 2.31 [95% CI, 1.45-3.67]), SIS category (HR, 3.37 [95% CI, 2.36-4.82]) and luminal stenosis degree (HR, 1.69 [95% CI, 1.15-2.48]) stratified by CAD-RADS (coronary artery disease reporting and Data System) 2.0 than in the lower ones. The CT-GRACE model integrating CACS category, SSS and GRACE 2.0 risk score was compared with the GRACE 2.0 risk score to evaluate their discrimination and reclassification ability in predicting 3-year mortality or MI. The C-statistics were 0.889 (0.842, 0.937) and 0.742 (0.659, 0.826) in the validation set, respectively (ΔAUC=0.147, P < 0.001). Coronary atherosclerosis plaque burden features could provide more meaningful information for GRACE 2.0 risk score to evaluate the intermediate-term prognosis for emergency NSTE-ACS.