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69 The use of grace score to risk stratify and the outcomes of a low risk cohort with acute coronary syndrome in a district general hospital

Introduction The Global Registry of Acute Coronary Events (GRACE) score is used to risk stratify patients admitted to hospital with non-ST elevated acute coronary syndrome (NSTEACS). The tool scores patients on the basis of age, physiological observations, symptoms, troponin measurements and ECG changes. The score helps stratify patients into low, medium and high risk NSTEACS in order for clinicians to prioritise their required treatment and/or intervention to improve mortality. Purpose We analysed the clinical outcomes and treatments received in a cohort of patients classified as low risk according to the GRACE score. Methods We collected the data for a cohort of patients admitted to a medium sized district general hospital (DGH) which offers angiography and coronary intervention within working hours We used the acute take list to identify the cohort of patients being treated as NSTEACS between June 2020 and August 2020. From the data collected we risk stratified the patients using the GRACE score as high, medium and low. We further analysed the low risk population to assess clinical outcomes and treatment received. Results A total of 158 patients were analysed. 85 patients (54%) were categorised as low risk. In the low risk population 56% were male and 34% were female with an average age of 55.8 (49.7-62.1). Within the low risk population 22 patients (26%) went forward to have an angiography following advice of the treating team. In those having an angiogram, 8 patients (36%) required a stent. Overall 8 out of the 85 patients categorised as low risk (7% of patients) required a stent insertion. Conclusion The GRACE score is used to predict patients with higher mortality rates therefore prioritising their treatment and time to PCI. Here 7% of patients proceeded to coronary stent implantation due to high grade coronary lesions in the context of low risk NSTEACS. The population seen at our DGH is diverse and may be younger patients at the time of index presentation with a higher burden of disease. However this raises the question whether risk stratification scores such as GRACE account sufficiently for socioeconomic and ethnic differences in populations. Conflict of Interest None