GRACE Calculator

Created by Łucja Zaborowska, MD, PhD candidate
Reviewed by Steven Wooding
Based on research by
Fox, K. A., Dabbous, O. H., Goldberg, R. J., Pieper, K. S., Eagle, K. A., Van de Werf, F., Avezum, A., Goodman, S. G., Flather, M. D., Anderson, F. A., Jr, & Granger, C. B. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ (Clinical research ed.) (November 2006)See 1 more source
Elbarouni, B., Goodman, S. G., Yan, R. T., Welsh, R. C., Kornder, J. M., Deyoung, J. P., Wong, G. C., Rose, B., Grondin, F. R., Gallo, R., Tan, M., Casanova, A., Eagle, K. A., Yan, A. T., & 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 American heart journal (September 2009)
Last updated: Jul 27, 2022

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](calc:235) or the [resting heart rate calculator](calc:2928).

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
<350
35-45(Age-35)*(1.8)
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)
≥90100

  1. Heart rate / Pulse
HR (bpm)Number of points
<500
50-60(HR-50)*(3/10)
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)
≥20046

  1. sBP - systolic blood pressure
sBP (mmHg)Number of points
<8058
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)
≥2000

  1. Creatinine
Creatinine mg/dLNumber of points
<0.2(Creatinine-0)*(1/0.2)
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)
≥4.028

  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, PhD candidate
Age
years
Pulse
bpm
Systolic BP
mmHg
Creatinine
μmol/L
Killip class
I (no signs of CHF)
Cardiac arrest
No
Segment ST deviation
No
Elevated cardiac enzymes
No
GRACE result
In-hospital
pts
Probability of death: -
Within 6 months from admission
pts
Probability of death: -
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