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Results:
Total number of patients in study was 150, out of which 90 (60%) were male and 60 (40%) were female. Out of the many risk factors for ACS, hypertension was the most prevalent in this study group with 60%. Dyslipidemia (53%), diabetes (50%), smoking (47%) family history (37%).
Patients were classified according to grace risk score 30 (20%) patients were in low risk category, 55 (37%) patients were in intermediate risk category, 65(43%) patients were in high risk category.STMI was found in 100( 67%) cases while NSTEMI in 27 (18%) cases and UA 23 (15%) cases.Age ranged between 30-80 years with statistical mean SD 57.94±11.24 years, more than 80% of patient had age above 50 years.
Heart rate ranged from 50 to 160 BPM with mean SD 97.43±27.79 BPM and half of cases had a heart rate more than 100 BPM.
Systolic blood pressure ranged from 80 to 170 mmHg with mean SD 116,83±24.34mmHg and hypotension (systolic BP 110bpm, SBP 60 years were at a high-risk which is compatible with sabah et al (28)and Rangamanikandan M et al (30).

In this study, higher heart rate at the time of admission was higher risk of mortality. In the GRACE registry, increasing HR was associated with worse outcome which is incompatible with sabah et al (28)and compatible with Rangamanikandan M et al.(30)

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In this study, There were 67% STEMI and 33% NSTEMI/UA patients, which is compatible with sabah et al (28) and with Samar Firdous, Muhammad Amir Mehmood et al.(31) This was explained by the fact that a transmural infarction has more extensive myocardial damage compared to NSTEMI and UA, since patients with STEMI usually have complete occlusion of an epicardial coronary artery(32).

In this study, a patient presenting in a higher Killips class was at higher risk for mortality. In the GRACE study also, increasing Killips class predicted worse prognosis, which is compatible with Philippe Gabriel Steg et al (33)

In this study, ST-segment deviation and positive cardiac biomarkers appears to identify the patient as being high risk, like a GRACE registry, ST-segment deviation and positive cardiac markers predicted worse prognosis, which is compatible with Rangamanikandan M et al (30)and sabah et a.l (28)

In this study, s.creatinine level at admission is an independent predictor of in-hospital mortality in patients with ACS (34), but there was no significant correlation with mortality in this study, which is compatible with sabah et al and incompatible with Rangamanikandan M et al.*

Like in the GRACE registry, our study also showed that a lower SBP at admission is significantly associated with more events, which is compatible with Rangamanikandan M et al (30)and sabah et al(28)

CONCLUSION:

By applying GRS in CCU for the patients with ACS will not only help to stratify patients according to their risk category, but it will be a useful indicator to reinforce urgent intervention among high risk individuals to reduce short term mortality and complications during hospital stay.

In hospitals with limited CCU beds like ours, it can be used GRACE as
a guide for referred patients with low scores to the general ward when CCU beds were fully occupied.

Recommendation:
1-GRACE RS should be studies in large numbers and in muli-centers.
2-GRCE RS should applied in every CCU to classified the patients according to there risk with advice to referred high risk patients to intervention.

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