GRACE ACS Risk and Mortality 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:
| Indicator | Value selection | Points for summing |
| Age | ||
| <30 | 0 | |
| 30 – 39 | 8 | |
| 40 – 49 | 25 | |
| 50 – 59 | 41 | |
| 60 – 69 | 58 | |
| 70 – 79 | 75 | |
| 80 – 89 | 91 | |
| >90 | 100 | |
| Heart rate/pulse beats/min | ||
| <50 | 0 | |
| 50 – 69 | 3 | |
| 70 – 89 | 9 | |
| 90 – 109 | 15 | |
| 110 – 149 | 24 | |
| 150 – 199 | 38 | |
| >200 | 46 | |
| >250 | 46 | |
| Systolic BP mm Hg | ||
| <80 | 58 | |
| 80 – 99 | 53 | |
| 100 – 119 | 43 | |
| 120 – 139 | 34 | |
| 140 – 159 | 24 | |
| 160 – 199 | 10 | |
| >200 | 0 | |
| Creatinine µmol/L | ||
| <35.36 | 1 | |
| 35.36 – 70.71 | 4 | |
| 70.72 – 106.07 | 7 | |
| 106.08 – 141.43 | 10 | |
| 141.43 – 176.7 | 13 | |
| 176.8 – 353 | 21 | |
| >=354 | 28 | |
| Other clinical parameters | ||
| Cardiac arrest at admission | YES | 39 |
| NO | 0 | |
| ST segment deviation on EKG | YES | 28 |
| NO | 0 | |
| Abnormal cardiac enzymes | YES | 14 |
| NO | 0 | |
| 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 points | Risk of death from hospitalization to 6 months |
| 0-87 | 0-2% |
| 88-128 | 3-10% |
| 129-149 | 10-20% |
| 150-173 | 20-30% |
| 174-182 | 40% |
| 183-190 | 50% |
| 191-199 | 60% |
| 200-207 | 70% |
| 208-218 | 80% |
| 219-284 | 90% |
| ≥ 285 | 99% |
For information regarding risk levels based on GRACE Score, the GRACE Research Group offers more information here.
Resources:
- 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.
- 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.
- 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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