Coronary Artery Calcium Scoring by Computed Tomography and the GRACE Risk Score as Predictors of Obstructive Coronary Artery Disease in Patients with Non-ST Segment Elevation Acute Coronary Syndrome: A Comparative Study

Abstract

Coronary artery disease (CAD), also referred to as ischemic heart disease (IHD), is the main global cause of death, accounting for more than 9 million deaths in 2016 according to the World Health Organization (WHO) estimates. CAD used to be known as a disease of the elderly but this concept changed nowadays. Globally, CAD was the leading killer in the age group ≥60 years. Now it is estimated that about 4–10 % of individuals with documented CAD are less than 45 years of age with 1,332,000 deaths in adults aged 15–59 years. Acute coronary syndrome (ACS) is a broad term representing a common end result which is acute myocardial ischemia. The use of multivariate risk score models has been shown to represent the most accurate way to predict risk, being superior to the subjective clinical impression. The Global Registry of Acute Coronary Events (GRACE) risk prediction model was developed from an earlier cohort of GRACE patients and has been extensively validated and shown to be a strong predictor of in hospital mortality across the spectrum. The use of imaging to directly measure the burden of atherosclerosis can provide a more personalized risk assessment than using risk factor-based calculators. Coronary artery calcium scoring (CACS) using computed tomography (CT) can be used to determine the actual presence and extent of calcified coronary artery plaque.