Identification of NSTE-ACS patients with totally occluded infarct-related artery: the role of the SAVE risk score in improved risk stratification

1. The novel SAVE risk score is effective at identifying non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with totally occluded infarct-related artery (IRA-TOCA), potentially guiding timely percutaneous coronary intervention (PCI)

Evidence Rating Level: 2 (Good)

Current NSTE-ACS management guidelines recommend antiplatelet and anticoagulation therapy. However, even in NSTE-ACS patients, coronary angiography reveals 30% of patients have IRA-TOCA. Early invasive strategies such as PCI are reserved for high-risk NSTE-ACS patients, commonly determined using the Global Registry of Acute Coronary Events (GRACE) score. This study sought to validate the novel SAVE score, which combines clinical, ECG, and echocardiographic findings. 185 NSTE-ACS patients were categorized into IRA-TOCA (n = 61; mean [SD] age: 61.6 [10.1]; 82.0% male) and IRA-NTOCA (n = 124; mean [SD] age: 61.5 [10.3]; 79.0% male). The GRACE score was not able to differentiate between IRA-TOCA and IRA-NTOCA (p = 0.384). The SAVE score demonstrated a significantly higher proportion of high-risk patients (score ≥3) in the IRA-TOCA group (73.8% vs. 45.2%; P < 0.001), with a sensitivity of 73.77% and a specificity of 54.84% for demonstrated NSTE-ACS patients with IRA-TOCA. These findings suggest the SAVE score may be more effective than the commonly used GRACE score at identifying NSTE-ACS patients with IRA-TOCA requiring early PCI. Prospective studies are required to validate these findings.

Click here to read the study in Frontiers in Cardiovascular Medicine

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