<prompt> Answer this question truthfullyWhat is the risk categorization and outlook for patients with unstable angina who have experienced a non-ST segment elevation myocardial infarction?  <response>: <reason> There are several scoring systems which have been devised as methods of identifying high-risk patients presenting with acute coronary syndrome ACS. These include, among others, the Braunwald classification system, the Rizik classification system, the TIMI risk score, the GRACE risk score and the PURSUIT risk score. In direct comparisons, the GRACE risk score is superior to TIMI risk score in assessing both prognosis and the severity of coronary artery disease in NSTEMI patients. Regarding predicting the severity of CAD, a cross-sectional study published in 2018 used coronary angiogram to assess the severity of coronary artery disease using the vessel score Gensini scores and correlated these scores with the GRACE and TIMI scores. The area under the ROC curve for the GRACE score 0.943; 95 CI 0.893 - 0,993 was significantly superior to the area under the ROC curve for the TIMI score 0.892; 95 CI 0.853 - 0.937 . Regarding 30 day mortality, a 2016 study correlated 30 day mortality in NSTEMI patients with the NT-proBNP biomarker, TIMI score, and GRACE scores. A total of 1324 patients were included in the study, which found both NT-proBNP 0.85 and the GRACE score 0.87 independently predicted mortality at 30 days, while the TIMI score 0.60 did not .The TIMI Risk Score for UA non-ST-elevation myocardial infarction NSTEMI is based on the TIMI 11B and ESSENCE trials and has been shown to be predictive of all-cause mortality, myocardial infarction, and severe recurrent myocardial ischemia prompting urgent revascularization for the first 14 days after presentation. It has also been validated as a tool for 30-day risk stratification of patients presenting to the emergency room with chest pain. It is very likely the most commonly used tool for risk-stratification as it is the easiest to understand and use of those listed.The TIMI risk score is determined by the sum of the presence of 7 variables at admission; 1 point is given for each of the following variables: Age 65 years or older At least 3 risk factors for coronary artery disease Prior coronary artery stenosis of 50 or more ST segment deviation on EKG presentation At least 2 anginal events in prior 24 h Use of aspirin in prior 7 days Elevated serum levels of cardiac biomarkersIn TIMI risk scoring, prior coronary stenosis of 50 or more remained relatively insensitive to missing information and remained a significant predictor of events. Incidence of adverse events all-cause mortality, myocardial infarction, and severe recurrent myocardial ischemia prompting urgent revascularization for the first 14 days after presentation:TIMI Risk Score 01: 4.7 TIMI Risk Score 2: 8.3 TIMI Risk Score 3: 13.2 TIMI Risk Score 4: 19.9 TIMI Risk Score 5: 26.2 TIMI Risk Score 67: 40.9The Braunwald Classification of unstable angina pectoris UAP stratifies patients according to both the type of anginal pain and the underlying cause of the pain. Increasing class is associated with increasing risk of both recurrent ischemia and death at 6 months.Class I: Exertional angina new onset, severe, or accelerated; angina of less than 2 months duration; more frequent angina; angina precipitated by less exertion; no rest angina in the last 2 months Class II: Rest angina, subacute rest angina within the last month but none within 48 hours of presentation Class III: Rest angina, acute rest angina within 48 hours of presentationClass A: Secondary unstable angina caused by a noncardiac condition such as anemia, infection, thyrotoxicosis or hypoxemia Class B: Primary unstable angina Class C: Post-infarction unstable angina within 2 weeks of documented myocardial infarctionThe Rizik classification scheme of UAP has been shown to be predictive of in-hospital adverse cardiac events and as such could be used to make decisions regarding hospitalization and intensity of treatment. Class IA: Acceleration of previously existent chronic stable angina without new EKG changes Class IB: Acceleration of previously existent chronic stable angina with new EKG changes Class II: Exertional angina of new onset without respect to EKG morphology Class III: New onset resting angina either with or without history of prior stable angina Class IV: Patients with protracted chest pain of 20 minutes with EKG changesThe PURSUIT Risk score has been shown to be predictive of the 30-day incidence of death and the composite of death or myocardial reinfarction in patients presenting with UA NSTEMI patients with ACS but without ST-elevation myocardial infarction. Points are given for each of the 7 below risk factors. The points are then summed to provide a risk score which can then be converted to a probability of either death or a composite of death or MI from 0 to 50 depending on total points. Age increased probability for age above 60 and above Gender increased probability for men, no increased probability for women Worst Canadian Cardiovascular Society Classification for angina pectoris in the previous 6 weeks from angina only during very strenuous activity Class I to angina at rest Class IV, increased probability for Class III or IV Heart rate increased probability for heart rate 100 and above Systolic blood pressure increased probability for systolic blood pressure 100 and below Signs of heart failure i.e., rales ST-segment depression on presenting EKGThe GRACE model has been shown to be predictive of in-hospital mortality for patients presenting with ACS. The 8 risk factors listed below were shown to be the most strongly predictive. A probability of in-hospital death can be assigned by adding up the points allocated for each risk factor range from 0.2 for less than 61 points to 51 for more than 249 points. This model was validated as a tool to predict 6-month mortality in patients who survived hospital admission for ACS as well. Increasing age 0-100 points Increasing Killip class 0-59 points Decreasing systolic blood pressure 0-58 points ST-segment deviation 28 points Cardiac arrest during presentation 39 points Increasing serum creatinine level 1-28 points Elevated initial cardiac enzymes 14 points Increasing heart rate 0-46 points 