This GRACE risk score calculator estimates mortality risk within 6 months to 3 years of myocardial infarction in patients with acute coronary syndrome. You can read more about the scoring system, the variables used and the result interpretation below the form.
How does this GRACE risk score calculator work?
This is a health tool that provides risk stratification of mortality from myocardial infarction in six months to 3 years time in patients with acute coronary syndrome both STEMI and non STEMI. The score can be calculated both at hospital admission and at discharge.
GRACE represents the Global Registry of Acute Coronary Events, an international observational data base studying patients with ACS.
This GRACE risk score calculator includes both ST segment elevation myocardial infarction (STEMI) and non ST segment elevation (non-STEMI).
The predictor variables used are 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. Along with the TIMI score, GRACE is one of the most popular mortality prognosis model for ACS.
GRACE score for ACS
These are the scores for each of the eight variables in the scoring system. According to the particular situation of the patient, the corresponding points will be summed and will provide the result which will then be interpreted based on the model guidelines.
| Age | Pts | 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 | ||
| Systolic BP (mmHg) | Pts | 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 |
| 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 |
| Cardiac arrest at admission | 39 |
| ST segment deviation | 28 |
| Abnormal cardiac enzymes | 14 |
Interpreting the results
GRACE scores provide a mortality risk stratification for ACS and vary for hospital mortality and 6 months prognosis and also according to ST for non ST elevation and ST elevation.
| 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% |
Acute coronary syndrome
This comprises of a group of conditions in which the heart muscle function is impaired or completely ceases due to a decrease in blood flow in the coronary arteries. This is a syndrome that usually requires emergency hospital admission as it is associated with coronary thrombosis and has different degrees of mortality risk according to individual patient data.
It usually comprises of either myocardial infarction, non Q wave myocardial infarction or unstable angina. The most common symptom is chest pain with radiating pain towards the left arm.
Electrocardiogram EKG investigation is used to distinguish between the various probable causes as well as investigations such as myocardial markers: troponin I or T and even D-dimer test if an accompanying pulmonary embolism is suspected.
References
1) 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.(2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ;333(7578):1091.
2) 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. (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med;163(19):2345-53.
3) Bawamia B, Mehran R, Qiu W, Kunadian V. (2013) Risk scores in acute coronary syndrome and percutaneous coronary intervention: a review. Am Heart J; 165(4):441-50.
4) Backus BE, Six AJ, Kelder JH, Gibler WB, Moll FL, Doevendans PA. (2011) Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department. Curr Cardiol Rev; 7(1): 2–8.
21 Jul, 2015