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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 2006See 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: Feb 05, 2024


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 patient.

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

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

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

Killip class

Signs/symptoms

I

No signs or symptoms of heart failure

II

Lungs rales/crackles, elevated jugular venous pressure

III

Acute pulmonary edema

IV

Cardiogenic 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? Compute the cardiovascular risk with the CVD calculator or the HEART score calculator. ❤️

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 arrest),

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

  1. Age

Age (years)

Number of points

<35

0

35-45

(Age-35)×(1.8)

45-55

18 + (Age-45)×(1.8)

55-65

36 + (Age-55)×(1.8)

65-75

54 + (Age-65)×(1.9)

75-85

73 + (Age-75)×(1.8)

85-90

91 + (Age-85)×(1.8)

≥90

100

  1. Heart rate / Pulse

HR (bpm)

Number of points

<50

0

50-60

(HR-50)×(3/10)

60-70

3 + (HR-60)×(3/10)

70-80

6 + (HR-70)×(3/10)

80-90

9 + (HR-80)×(3/10)

90-100

12 + (HR-90)×(3/10)

100-110

15 + (HR-100)×(3/10)

110-150

18 + (HR-110)×(12/40)

150-200

30 + (HR-150)×(16/50)

≥200

46

  1. sBP - systolic blood pressure

sBP (mmHg)

Number of points

<80

58

80-100

58 - (sBP-80)×(10/20)

100-110

48 - (sBP-100)×(5/10)

110-120

43 - (sBP-110)×(4/10)

120-130

39 - (sBP-120)×(5/10)

130-140

34 - (sBP-130)×(5/10)

140-150

29 - (sBP-140)×(5/10)

150-160

24 - (sBP-150)×(5/10)

160-180

19 - (sBP-160)×(9/20)

180-200

10 - (sBP-180)×(10/20)

≥200

0

  1. Creatinine

Creatinine mg/dL

Number of points

<0.2

(Creatinine-0)×(1/0.2)

0.2-0.4

1 + (Creatinine-0.2)×(2/0.2)

0.4-0.6

3 + (Creatinine-0.4)×(1/0.2)

0.6-0.8

4 + (Creatinine-0.6)×(2/0.2)

0.8-1.0

6 + (Creatinine-0.8)×(1/0.2)

1.0-1.2

7 + (Creatinine-1.0)×(1/0.2)

1.2-1.4

8 + (Creatinine-1.2)×(2/0.2)

1.4-1.6

10 + (Creatinine-1.4)×(1/0.2)

1.6-1.8

11 + (Creatinine-1.6)×(2/0.2)

1.8-2.0

13 + (Creatinine-1.8)×(1/0.2)

2.0-3.0

14 + (Creatinine-2.0)×(7/1)

3.0-4.0

21 + (Creatinine-3.0)×(7/1)

≥4.0

28

  1. Killip class

Class

Number of points

I class

0

II class

20

III class

39

IV class

59

  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.

FAQ

What is the GRACE score in ACS?

The GRACE (Global Registry of Acute Coronary Events) score assesses the risk of in-hospital mortality of patients with ACS (Acute Coronary Syndrome).

It is used by clinicians to understand their patients' prospects and make the best decisions based on this 1-3-year prediction.

What happens in ACS?

Acute coronary syndrome corresponds to conditions that cause a sudden and severely reduced blood supply to the heart. Under this spectrum fall heart attacks and unstable angina.

How do you calculate the risk of death for ACS?

To calculate the mortality risk for ACS with the GRACE score, follow these steps:

  1. Determine your patient's heart rate.

  2. Measure the systolic blood pressure.

  3. Find the concentration of creatinine in your patient's blood.

  4. Determine the Killip class for your patient.

  5. Assess the presence of cardiac arrest, segment ST deviation, and elevated cardiac enzymes for your patient.

  6. Along with age, enter all values in the formula:

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

  7. That's it! Now, you have a reliable prediction of the mortality risk of your ACS patient.

What are the risk factors for developing ACS?

The main risk factors for ACS are high blood pressure, smoking, diabetes, high fat levels, obesity, poor diet, lack of physical activity, and a family history of this health condition.

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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