Prognostic value of GRACE and EDACS scores in patients diagnosed with Non-ST-elevation myocardial infarction presenting to the emergency department

Objective: This study aimed to evaluate the prognostic value of the GRACE and EDACS risk scores in patients presenting to the emergency department with a diagnosis of non-ST-elevation myocardial infarction (Non-STEMI). Specifically, the study investigated the relationship of these scores with 30-day major adverse cardiovascular events (MACE) and the presence of significant coronary artery lesions. Methods: This retrospective, single-center study included 332 patients who presented to the emergency department between January 1, 2022, and December 31, 2024, and were diagnosed with non–ST-elevation myocardial infarction (NSTEMI) based on the criteria defined in the 2023 ESC guidelines. Following approval by the institutional ethics committee, data were collected using ICD-10 codes, electronic medical records, and coronary angiography reports. Demographic characteristics, vital signs, laboratory parameters, electrocardiographic findings, and Killip class at presentation were systematically recorded. Significant coronary artery disease was defined as the presence of ≥70% luminal stenosis or total occlusion on primary percutaneous coronary angiography. The relationship between 30-day all-cause mortality and the presence of significant coronary lesions was assessed in relation to GRACE and EDACS scores, as well as their constituent clinical variables. Results: The EDACS score predicted significant coronary lesions more accurately than the GRACE score (AUC: 0.654 vs. 0.522; p<0.001), with a >12.5 cutoff demonstrating 87.7% sensitivity. The GRACE score showed strong predictive value for in-hospital mortality, with 2% mortality in the low-risk group and 16.1% in the high-risk group. EDACS score was also significantly associated with mortality (p=0.022). While GRACE provided better performance in mortality prediction, EDACS showed superior discrimination in identifying low-risk patients, highlighting its potential as a clinical decision-support tool. Conclusion: This study is among the few that compare the prognostic performance of the EDACS score with the widely used GRACE score in Non-STEMI patients presenting to the emergency department. Findings suggest that EDACS is more effective in predicting significant coronary artery stenosis and may be particularly valuable for safely identifying low-risk patients eligible for discharge. While the GRACE score remains robust in estimating mortality among high-risk patients, EDACS offers practical advantages with its simplicity and rapid applicability. Considering their complementary strengths, the combined use of both scores may enhance clinical decision-making and improve the safety and efficiency of patient management in Non-STEMI care. Keywords: Non-STEMI, GRACE Score, EDACS Score