With data lacking on acute coronary syndrome (ACS) in patients with heart failure (HF), researchers examined the characteristics and outcomes of non-ST elevation ACS (NSTACS) in patients with and without a prior medical history of HF and the GRACE risk performance for risk stratification in both groups. The study team retrospectively analyzed 5,661 consecutive patients admitted for an NSTACS in two Spanish tertiary hospitals between November 2003 and November 2017, dividing patients according to history of HF. Logistic regression models were used to predict mortality in both groups, as the GRACE score indicates mortality in 6 months.

Patients with HF had higher Killip class, GRACE and CRUSADE scores, more complications (such as major bleeding, worsening HF, and acute kidney injury), and higher mortality. The discrimination capacity of GRACE score to predict mortality at 6 months was slightly higher in patients without HF (area under the curve [AUC], 83.9%) than in patients with HF (AUC, 77.0%), and the risk score calibration was acceptable for both groups, with Brier scores of 0.139 for patients with HF and 0.046 for patients without HF. Patients with HF and lower GRACE scores had increased predicted mortality compared with patients without HF. The results demonstrate the potential utility of the GRACE risk score in patients with HF admitted for NSTACS, furthering the use of the score into that patient population, according to the study authors.