GRACE ACS Risk and Mortality Calculator

GRACE calculator

Estimates admission-6 month mortality for patients with acute coronary syndrome on the GRACE scale (Global Registry of Acute Coronary Events). Patients with known STEMI or unstable angina/NSTEMI, to determine mortality risk.

Cardiac arrest at admission Yes No

ST segment deviation on EСG Yes No

Abnormal cardiac enzymes Yes No

Killip class (signs/symptoms):
Cardiogenic shock (IV)
Acute pulmonary edema (III)
Wheezing in the lungs and/or high pressure in the jugular veins (II)
No signs of congestive heart failure (I)



Total points Risk of death from hospitalization to 6 months
0 0

Formula

The GRACE score is the sum of the following parameters:

IndicatorValue selectionPoints for summing
Age  
 <300
 30 – 398
 40 – 4925
 50 – 5941
 60 – 6958
 70 – 7975
 80 – 8991
 >90100
Heart rate/pulse beats/min  
 <500
 50 – 693
 70 – 899
 90 – 10915
 110 – 14924
 150 – 19938
 >20046
 >25046
Systolic BP mm Hg  
 <8058
 80 – 9953
 100 – 11943
 120 – 13934
 140 – 15924
 160 – 19910
 >2000
Creatinine µmol/L  
 <35.361
 35.36 – 70.714
 70.72 – 106.077
 106.08 – 141.4310
 141.43 – 176.713
 176.8 – 35321
 >=35428
Other clinical parameters  
Cardiac arrest at admissionYES39
 NO0
ST segment deviation on EKGYES28
 NO0
Abnormal cardiac enzymesYES14
 NO0
Killip class (signs/symptoms)  Cardiogenic shock (IV)59
 Acute pulmonary edema (III)39
 Wheezing in the lungs and/or high pressure in the jugular veins (II)20
 No signs of congestive heart failure (I)0

Interpretation that we must issue as a result of mandatory fields

Total pointsRisk of death from hospitalization to 6 months
0-870-2%
88-1283-10%
129-14910-20%
150-17320-30%
174-18240%
183-19050%
191-19960%
200-20770%
208-21880%
219-28490%
≥ 28599%

For information regarding risk levels based on GRACE Score, the GRACE Research Group offers more information here.

Resources:

  1. Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum A, Goodman SG, Flather MD, Anderson FA Jr, Granger CB. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006 Nov 25;333(7578):1091. doi: 10.1136/bmj.38985.646481.55. Epub 2006 Oct 10. PMID: 17032691; PMCID: PMC1661748.
  2. Fox KA, Fitzgerald G, Puymirat E, Huang W, Carruthers K, Simon T, Coste P, Monsegu J, Gabriel Steg P, Danchin N, Anderson F. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014 Feb 21;4(2):e004425. doi: 10.1136/bmjopen-2013-004425. PMID: 24561498; PMCID: PMC3931985.
  3. Elbarouni B, Goodman SG, Yan RT, Welsh RC, Kornder JM, Deyoung JP, Wong GC, Rose B, Grondin FR, Gallo R, Tan M, Casanova A, Eagle KA, Yan AT; Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)) Investigators. Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada. Am Heart J. 2009 Sep;158(3):392-9. doi: 10.1016/j.ahj.2009.06.010. PMID: 19699862.
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