GRACE Risk Score

Determines mortality risk from myocardial infarction within 6 months to 3 years, for patients with acute coronary syndrome.

In the text below the calculator you can read more about the score items and its interpretation.


The GRACE risk score is used in the assessment of patients with acute coronary syndrome, be it STEMI or non-STEMI.

It stratifies risk of mortality from myocardial infarction in six months to 3 years’ time.

The acronym comes from the Global Registry of Acute Coronary Events, an international observational database studying patients with ACS.


Acute Coronary Syndrome (ACS) includes conditions such as myocardial infarction, non Q wave myocardial infarction or unstable angina which occur due to a decrease or cessation of blood flow in coronary arteries, followed by impairment of the cardiac muscle.

GRACE score was developed by Fox et al. in 2006 following a study on a population of 43,810 patients from 94 worldwide hospitals, admitted with ST- and non-ST elevation ACS.


1

Patient age

2

Heart rate

3

Systolic BP

4

Creatinine

5

Killip Class

6

Cardiac arrest at admission

7

ST segment deviation

8

Abnormal cardiac enzymes

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GRACE score explained

The GRACE risk score stratifies mortality risk (6 mo – 3 y) from myocardial infarction (ST- elevation and non-ST elevation) in patients suffering from acute coronary syndrome.

GRACE comes from the Global Registry of Acute Coronary Events, an international ACS database and is calculated at hospital admission and at discharge.

There are eight variables taken into account: patient age, heart rate (HR), systolic blood pressure (SBP), serum creatinine, Killip heart failure class, the existence or not of cardiac arrest at admission, any deviations of the ST segment and cardiac enzyme levels.

The values introduced for the first four and the presence of the other four, are weighted differently in the final score.

The scoring guidelines are introduced in the following tables:

1) Age Pts 2) Heart Rate (bpm) Pts
<30 0 <50 0
30 - 39 8 50 - 69 3
40 - 49 25 70 - 89 9
50 - 59 41 90 - 109 15
60 - 69 58 110 - 149 24
70 - 79 75 150 - 199 38
80 - 89 91 ≥200 46
≥90 100  
3) Systolic BP (mmHg) Pts 4) Creatinine Level (mg/dL) Pts
<80 58 0 - 0.39 1
80 - 99 53 0.40 - 0.79 4
100 - 119 43 0.8 - 1.19 7
120 - 139 34 1.20 - 1.59 10
140 - 159 24 1.6 - 1.99 13
160 - 199 10 2.0 - 3.99 21
≥200 0 ≥4 28
5) Killip classification of prior or current congestive heart failure
Cardiogenic shock 59
Acute pulmonary edema 39
Rales and/or jugular venous distension 20
No CHF 0
6) Cardiac arrest at admission 39
7) ST segment deviation 28
8) Abnormal cardiac enzymes 14

There are other mortality prognosis tools for patients with ACS, such as the TIMI score (Thrombolysis in Myocardial Infarction).

 

Score interpretation

The mortality risk stratification is provided for both ST-elevation and non-ST elevation ACS and for hospital mortality and 6 months prognosis:

ST elevation - Acute coronary syndrome
Setting Score Risk Mortality
In hospital <126 Low <2%
In hospital 126 - 154 Intermediate 2 - 5%
In hospital >154 High >5%
6 months <100 Low <4.5%
6 months 100 - 127 Intermediate 4.5 - 11%
6 months >127 High >11%
non ST elevation - Acute coronary syndrome
Setting Score Risk Mortality
In hospital <109 Low <1%
In hospital 109 - 140 Intermediate 1 - 3%
In hospital >140 High >3%
6 months <89 Low <3%
6 months 89 - 118 Intermediate 3 - 8%
6 months >118 High >8%
 

About the study

GRACE score was developed by Fox et al. in 2006 following a study on a population of 43,810 patients from 94 worldwide hospitals (21,688 in derivation set and 22,122 in validation set).

The main outcome measures considered were death and myocardial infarction. The research used multivariable regression to develop a final predictive model, with prospective and external validation.

The factors found to have independent predictability were included in the score. It was found that GRACE is a reliable risk prediction tool for cumulative six-month risk of death or myocardial infarction across the spectrum of patients with ACS.

 

Acute coronary syndrome

ACS is the name given to a group of cardiovascular conditions in which the muscular function of the heart is impaired or completely ceases due to a decrease in coronary artery blood flow.

These include: myocardial infarction, non Q wave myocardial infarction or unstable angina. Their most common symptom is chest pain which radiates towards the left arm.

Conditions pertaining to ACS require emergency hospital admission and are associated with different degrees of mortality risk.

Differential diagnosis is supported by Electrocardiogram EKG investigation and determination of myocardial markers (Troponin I or T, amongst others).

When an accompanying pulmonary embolism is suspected, a D-dimer test is also ordered.

 

Original source

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; 333(7578):1091.

Validation

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; 158(3):392-9.

Other references

1. Granger CB1, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003; 163(19):2345-53.

2. Backus BE, Six AJ, Kelder JH, Gibler WB, Moll FL, Doevendans PA. Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department. Curr Cardiol Rev. 2011; 7(1): 2–8.


App Version: 1.0.1

Coded By: MDApp

Specialty: Cardiology

System: Cardiovascular

Objective: Mortality Predictor

Type: Score

No. Of Items: 8

Year Of Study: 2006

Abbreviation: GRACE

Article By: Denise Nedea

Published On: April 19, 2017 · 07:08 AM

Last Checked: April 19, 2017

Next Review: April 19, 2018