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Background  Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up.    Methods  Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely  GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG . The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization.    Results  During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of  ACEF  and  SYNTAX II PCI  scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29,  P  = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00–1.05,  P  = 0.023 and HR 2.02, 95% CI 1.04–3.89,  P  = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with  ACEF  score (HR 2.16, 95% CI 1.36–3.44,  P  = 0.001). The overall performance of  GRACE ,  SYNTAX ,  Clinical SYNTAX  and  SYNTAX II CABG  was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while  ACEF  and  SYNTAX II PCI  showed the best absolute AUC values for MACE (0.630 and 0.626, respectively).    Conclusions   ACEF  risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.

ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up