Interpretation
| Result | Meaning |
|---|---|
| ≤ 60 | ≤ 0.2% |
| 100 | 0.8% |
| 140 | 2.9% |
| 160 | 5.4% |
| 180 | 9.8% |
| 200 | 18% |
| 220 | 29% |
| 240 | 44% |
| ≥ 250 | ≥ 52% |
Formula
Points: Killip (I 0, II 20, III 39, IV 59) · SBP (< 80: 58, 80–99: 53, 100–119: 43, 120–139: 34, 140–159: 24, 160–199: 10, ≥ 200: 0) · HR (< 50: 0, 50–69: 3, 70–89: 9, 90–109: 15, 110–149: 24, 150–199: 38, ≥ 200: 46) · Age (< 30: 0, 30–39: 8, 40–49: 25, 50–59: 41, 60–69: 58, 70–79: 75, 80–89: 91, ≥ 90: 100) · Creatinine mg/dL (< 0.4: 1, 0.4–0.79: 4, 0.8–1.19: 7, 1.2–1.59: 10, 1.6–1.99: 13, 2.0–3.99: 21, ≥ 4: 28) · cardiac arrest 39 · ST deviation 28 · elevated enzymes 14. Mortality from the published nomogram (points 60→0.2%, 70→0.3, 80→0.4, 90→0.6, 100→0.8, 110→1.1, 120→1.6, 130→2.1, 140→2.9, 150→3.9, 160→5.4, 170→7.3, 180→9.8, 190→13, 200→18, 210→23, 220→29, 230→36, 240→44, 250→52), linearly interpolated between 10-point steps.
Clinical pearls
- This is the original in-hospital model; the GRACE 2.0 and 6-month post-discharge models use different equations and give different numbers.
- Risk tertile cut-offs (108/140) are for NSTE-ACS; for STEMI the corresponding tertiles are higher (≤125, 126–154, ≥155).
Examples
grace score 72M hr 95 sbp 110 creatinine 1.4 killip 2 st depression troponin positiveGRACE in-hospital mortality for a 65 year old woman, pulse 80, BP 130/80, creatinine 88 umol/L, Killip I, ST deviation, elevated troponin, no arrestgrace acs 85 yo hr 120 sbp 90 cr 2.1 killip 3
FAQ
What GRACE score is high risk?
For NSTE-ACS, a GRACE in-hospital score above 140 (in-hospital mortality above 3%) is high risk and favours an early invasive strategy within 24 hours.
Is GRACE better than TIMI?
GRACE generally discriminates mortality better than TIMI, at the cost of more inputs; TIMI is simpler at the bedside.