J Transcat Intervent.2019;27:eA201905.
Out of sight, out of scores!
The attempt to identify patients who are more likely to present events, whether or not related to interventions, is a long search preceding the era of catheters.1.2 In 1977, for example, some of the most important predictors of adverse events related to coronary artery disease (CAD) were defined, such as the number of coronary vessels or territories involved, and the extent of myocardium at risk. The prognostic capacity of these variables was demonstrated to increase with the incorporation of other variables, like the degree of coronary obstruction. At the time, the Duke Jeopardy score was developed, and validated in 1985.
The perception that combined variables could increase the capacity to predict major events, due to an additive effect, started to gradually gain momentum. The current clinical guidelines of the European Society of Cardiology (ESC), American College of Cardiology (ACC), and American Heart Association (AHA) recommend the use of the Global Registry of Acute Coronary Events (GRACE) or the Thrombolysis in Myocardial Infarction (TIMI) risk scores for stratification of individual patients, and the GRACE is validated for all acute coronary syndromes (ACS) presentations, with or without ST segment elevation. Several studies have shown that the GRACE is better in discriminating individuals at greater clinical risk, , but neither of the two was intended and/or validated to predict CAD extent and severity before complete, invasive stratification using coronary angiography.