Comparison of clinical risk assessment systems in predicting three-vessel coronary artery disease and angiographic culprit lesion in patients with non-ST segment elevated myocardial infarction/unstable angina pectoris.

BACKGROUND

We wanted to compare the values of clinical risk assessments and scoring systems for predicting three-vessel diseases and culprit lesions by coronary angiography in patients with unstable angina pectoris (UAP), or non-ST segment elevation myocardial infarction (NSTEMI).

METHODS

A total of 154 consecutive patients, (42 [27.3%] female, and 112 [72.7%] male, mean age: 63.0 ± 12.7 years) with UAP/NSTEMI were enrolled. Rizik and Braunwald classification, ACC/AHA risk assessment system, TIMI, GUSTO, GRACE and PURSUIT risk scores were determined, and the ROC curve was marked in accordance with the presence of three-vessel disease and culprit lesion.

RESULTS

In patients with NSTEMI, the rates of three-vessel disease and culprit lesion were demonstrated to be higher. With respect to the presence of three-vessel disease, only the ACC/AHA risk assessment was manifested to have a predictive value. All risk scoring systems were demonstrated to bear predictive values with different sensitivity and specificity. The TIMI and GRACE risk scores were discovered to have higher predictive values. The presence of culprit lesions could not be predicted by any of the risk assessment or scoring systems.

CONCLUSIONS

Among risk assessment systems, only the ACC/AHA system can be used to predict three-vessel disease. It is possible to use all risk scoring systems for the same purpose. The predictive values of the TIMI and GRACE risk scores are higher. The culprit lesions cannot be predicted by any of the risk assessment or scoring systems. The use of cardiac enzymes seems more appropriate with very low sensitivity and specificity.