Risk stratification in non-ST-elevation myocardial infarction: evaluating the predictive accuracy of various risk scores in an Indian population

Risk stratification is essential in managing patients with non-ST-elevation myocardial infarction (NSTEMI). While multiple risk scores exist, their validation in developing countries like India remains limited. This study compares the predictive accuracy of the PURSUIT, HEART, TIMI, GRACE 2.0, and CAMI-NSTEMI scores for major adverse cardiovascular events (MACE), including death, non-fatal myocardial infarction, emergency percutaneous coronary intervention, and coronary artery bypass grafting, in NSTEMI patients. This was a single-center prospective observational study wherein patients diagnosed with NSTEMI were enrolled. Detailed clinical histories, including symptomatology and risk factors, were recorded. Five risk scores (TIMI, GRACE 2.0, PURSUIT, HEART, and CAMI-NSTEMI scores) were computed. Outcomes were assessed for in-hospital, 14-day, six-month, and one-year MACE. A total of 1102 patients were enrolled, with a mean age of 59.6±11.2 years. MACE occurred in 140 patients (12.7%), with 89 deaths (8.1%). Patients with MACE were older and more likely to smoke or have hypertension, diabetes, or stroke. Multivariate logistic regression analysis identified angina in the last 48 hours, diabetes, smoking, cardiac arrest, and fragmented QRS on electrocardiogram as independent MACE predictors. TIMI showed the highest predictive ability for in-hospital MACE, while GRACE excelled for 14-day, 6-month, and 1-year outcomes. All risk scores effectively predicted short- and intermediate-term MACE, with GRACE performing best for longer-term predictions.