GRACE Calculator

By Łucja Zaborowska, MD
Last updated: Oct 16, 2020

GRACE calculator is a tool that estimates the probability of death in acute coronary syndrome (ACS) patients.

Our GRACE score calculator supports two different models: in-hospital deaths by Granger, and admission-6-months mortality by Fox.

Follow the article below for the GRACE score definition and detailed explanation. ⤵️

What is the GRACE risk score?

GRACE stands for The Global Registry of Acute Coronary Events. GRACE was an international registry, gathering data from over 250 hospitals all around the world. The project enrolled over 100,000 patients with acute coronary syndrome and followed their in-hospital and long term outcomes. 🌎

This cooperation started in 1999 and resulted in an ACS calculator for assessing the risk and mortality among this kind of patients.

GRACE risk score 2.0 is an improved version of the GRACE score. It allows clinicians to make decisions based on 1- or 3- years predictions.

You may also check another reliable tool for calculating mortality rates in patients with unstable angina or NSTEMI - TIMI score.

How to use the GRACE calculator?

Our ACS risk calculator consists of 8 variables, including 4 that require numerical input:

  1. Age given in years;
  2. Pulse given in beats per minute;
  3. Systolic blood pressure; and
  4. Creatinine given in mg/dL or μmol/L.
💡 You can read more about the subject in our other useful tools: heart rate multitool or the resting heart rate calculator.

You will also need to know the Killip Class. The following table describes the signs/symptoms of each class.

Killip classSigns/symptoms
INo signs or symptoms of heart failure
IILungs rales/crackles, elevated jugular venous pressure
IIIAcute pulmonary edema
IVCardiogenic shock/systolic blood pressure <90 mmHg/ signs of vasoconstriction (oligouria, cyanosis etc)

Your next step will consist of evaluating the presence or absence of the following abnormalities:

  • Cardiac arrest (loss of blood flow);
  • Segment ST deviation (elevation or depression); and
  • Elevated cardiac enzymes, such as myoglobin, troponin or creatine kinase.

Your result will include the GRACE cardiovascular risk score calculated in two separate models:

  • In hospital
  • Up to 6 months after admission

You'll also see predicted mortality rates.

You've already got your results - how about discovering something new?

How to calculate the GRACE risk score for ACS?

Here, we present and explain charts for the In-hospital mortality. For other charts and different models, visit Center for Outcomes Research, University of Massachusetts Medical School.

Our GRACE risk score calculator online uses the following equation:

In-hospital mortality = Killip class + sBP + Heart rate + Age + Creatinine + (28 * ST deviation) + (14 * Elevated cardiac enzymes) + (39 * Cardiac arest),

where each variable is converted into points using the following tables:

  1. Age
Age (years)Number of points
45-5518 + (Age-45)*(1.8)
55-6536 + (Age-55)*(1.8)
65-7554 + (Age-65)*(1.9)
75-8573 + (Age-75)*(1.8)
85-9091 + (Age-85)*(1.8)

  1. Heart rate / Pulse
HR (bpm)Number of points
60-703 + (HR-60)*(3/10)
70-806 + (HR-70)*(3/10)
80-909 + (HR-80)*(3/10)
90-10012 + (HR-90)*(3/10)
100-11015 + (HR-100)*(3/10)
110-15018 + (HR-110)*(12/40)
150-20030 + (HR-150)*(16/50)

  1. sBP - systolic blood pressure
sBP (mmHg)Number of points
80-10058 - (sBP-80)*(10/20)
100-11048 - (sBP-100)*(5/10)
110-12043 - (sBP-110)*(4/10)
120-13039 - (sBP-120)*(5/10)
130-14034 - (sBP-130)*(5/10)
140-15029 - (sBP-140)*(5/10)
150-16024 - (sBP-150)*(5/10)
160-18019 - (sBP-160)*(9/20)
180-20010 - (sBP-180)*(10/20)

  1. Creatinine
Creatinine mg/dLNumber of points
0.2-0.41 + (Creatinine-0.2)*(2/0.2)
0.4-0.63 + (Creatinine-0.4)*(1/0.2)
0.6-0.84 + (Creatinine-0.6)*(2/0.2)
0.8-1.06 + (Creatinine-0.8)*(1/0.2)
1.0-1.27 + (Creatinine-1.0)*(1/0.2)
1.2-1.48 + (Creatinine-1.2)*(2/0.2)
1.4-1.610 + (Creatinine-1.4)*(1/0.2)
1.6-1.811 + (Creatinine-1.6)*(2/0.2)
1.8-2.013 + (Creatinine-1.8)*(1/0.2)
2.0-3.014 + (Creatinine-2.0)*(7/1)
3.0-4.021 + (Creatinine-3.0)*(7/1)

  1. Killip class
ClassNumber of points
I class0
II class20
III class39
IV class59

  1. ST deviation, Elevated cardiac enzymes, Cardiac arrest

    All three variables can take the following values:

    • If present: 1
    • If absent: 0

Citation for the above tables: Copyright 1998-2014, Center for Outcomes Research, University of Massachusetts Medical School.

Disclaimer: This calculator cannot be a substitute for medical advice and shouldn't be the single source for any medical decision.

Łucja Zaborowska, MD
Systolic BP
Killip class
I (no signs of CHF)
Cardiac arrest
Segment ST deviation
Elevated cardiac enzymes
GRACE result
Probability of death: -
Within 6 months from admission
Probability of death: -
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