30th May 2026

Prognosis

Mortality

• Overall mortality in NSTE-ACS patients is 4.8% over 6 months.
• Mortality rates exceed those of STEMI after 6 months.
• At 12 months, adverse cardiovascular events (recurrent ischemia, MI, and death) occur in up to 10% of patients, likely reflecting widespread atherosclerotic disease.

Prognostic Factors

• Adverse markers include rest pain, comorbidities (e.g., diabetes, hypertension, chronic kidney disease), left ventricular failure, ST depression, raised biomarkers, and multi-vessel or left main disease.
• Short-term risk factors for death or non-fatal MI include:
  • Accelerated ischemic symptoms, prolonged rest pain, pulmonary oedema, new mitral regurgitation, age >75, and significant ECG changes (ST-T changes, new bundle branch block, sustained VT).

Risk Assessment

Risk models (e.g., GRACE Score) predict outcomes for up to 6 months and maintain predictive value for 1-year outcomes such as death or MI.

• The GRACE score takes into account factors such as patient age, cardiac history, ECG findings, signs and symptoms, and gives a score to estimate 6-month mortality.