The therapeutic decision for the patients with non-ST elevation acute coronary syndrome depends on early risk stratification. The GRACE and TIMI risk scores are commonly used for risk stratification in this group of patients at presentation. There is insufficient evidence on value of risk scores in predicting the need for coronary revascularization. We aimed to evaluate the utility of GRACE and TIMI risk scores to predict the requirement for coronary revascularization in patients with non-ST elevation acute coronary syndrome.

The cross-sectional study was done in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from April 2017 to March 2019 over a period of two years. We studied 315 patients presented with non-ST elevation acute coronary syndrome. Patients were evaluated to calculate GRACE and TIMI risk score using online calculator. Coronary angiogram was done during index hospitalization and the need for coronary revascularization was assessed by angiographic vessel score.  

A positive correlation of the angiographic vessel score to predict the need for coronary revascularization with both GRACE and TIMI risk scores (p= <0.001) was found. The ability of GRACE and TIMI risk scores to predict the need for coronary revascularization was estimated by plotting Receiver Operating Characteristic (ROC) curve. The cut off for GRACE risk score was 123.5 (AUC= 0.821; p= <0.001; 95% CI= 0.801-0.914) with a sensitivity of 77% and specificity of 51.8% and the cut off for TIMI risk score was 2.8 (AUC= 0.759; p= <0.001; 95% CI= 0.731-0.801) with a sensitivity of 68% and specificity of 39.1%. Statistically significant difference between two AUC (0.062) for the superiority of GRACE score was found.

Both the GRACE and TIMI risk scores showed good predictive accuracy in predicting the need for coronary revascularization in patients with non-ST elevation acute coronary syndrome, when they were compared, the GRACE score was found to be superior to the TIMI score.