Score of Gohbara et al for Distinguishing Obstruction Versus Spasm of a Coronary Artery in a Patient with Acute Coronary Syndrome Without Persistent ST-Segment Elevation
Gobhar et al reported a simple score for evaluating a patient with acute coronary syndrome (ACS) without persistent ST-segment elevation. The score can help to distinguish patients with coronary artery spasm from those with coronary artery obstruction. The authors are from Yokohama City University in Japan.
Patient selection: acute coronary syndrome (ACS) without persistent ST-segment elevation
Parameters:
(1) age of the patient in years
(2) NSTEMI
(3) diabetes mellitus
(4) serum BNP in pg/mL
(5) neurophil to lymphocyte ratio
(6) serum HDL cholesterol in mg/dL
Parameter
Finding
Points
age in years
<= 70 years
0
> 70 years
6
NSTEMI
no
0
yes
9
diabetes mellitus
no
0
yes
5
serum BNP
<= 90 pg/mL
0
> 90 pg/mL
7
neutrophil to lymphocyte ratio
<= 2
0
> 2
5
HDL cholesterol
< 50 mg/dL
5
>= 50 mg/dL
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 37
• A score < 20 favors coronary spasm while a score >= 20 favors coronary artery obstruction.
Total Score
Quartile
Spasm-Induced ACS
0 to 13
1
50%
14 to 19
2
20%
20 to 26
3
5-8%
27 to 37
4
2%
Performance:
• The area under the ROC curve for coronary artery obstruction was 0.85.
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