Aims: Coronary risk stratification using GRACE score [Global Registry of Acute Coronary Events] and early treatment is beneficial in NSTEMI [Non ST elevation Myocardial Infarction]. We aimed to evaluate utility of peak systolic Global Longitudinal Strain [GLS] score along with GRACE score in identifying patients at high risk for cardiac events & to observe any gender related impact of these scores in predicting MACE [Major Adverse Cardiac Events] following an episode of NSTEMI.

Methods: We prospectively studied 636 patients admitted to Medical College, Kottayam, India with diagnosis of NSTEMI during the period of 3 years from 2014 to 2017. All patients were categorised in to low, moderate and high GRACE score groups along with GLS score measurement. 6 months MACE was statistically analysed.

Results: Females with NSTEMI had less negative GLS scores compared to male counterparts. The optimal cut off value of GLS for prediction of significant Coronary artery disease [CAD] in at least one coronary arterial territory in the study population was found as ≥-15.7 (AUC 0.797, p value 0.009). The sensitivity, specificity and positive predictive value [PPV] of GLS for detecting significant CAD were 89%, 70%, and 83.3% respectively. 6 months MACE was high in females compared to males with similar levels of GRACE score. MACE in different GRACE groups were higher when the GLS score was ≥-15.7.

Conclusion: In patients with NSTEMI, simple bedside echocardiographic assessment of peak systolic GLS score calculation, when used with the GRACE score can increase the prognostic value, especially in females. For comparable GRACE scores ,the risk of cardiac events were higher in females compared to males when the GLS score is ≥-15.7.

Keywords: NSTEMI, GRACE score, Global longitudinal strain.

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Dr Suresh Madhavan

Associate professor, Government Medical College, Kottayam, Kerala, India 686008