The GRACE risk score

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Rim Halaby, M.D. [2]

Overview

The Global Registry of Acute Coronary Events (GRACE) risk score has been developed for the assessment of the risk of death among patients with acute coronary syndrome. There is a GRACE risk score for the estimation of in-hospital mortality and another for mortality in the period from the time of hospital discharge up to 6 months.[1][2]

Grace Risk Score for In-Hospital Mortality

Calculation of Grace Risk Score for In-Hospital Mortality

The total GRACE risk score is calculated by adding the points assigned to the different variable shown below. The highest total possible score 363.[1]

Variable Points
Age (years)
<30 0
30–39 8
40–49 25
50–59 41
60–69 58
70–79 75
80–89 91
≥90 100
Heart rate (beats/minute)
<50 0
50–69 3
70–89 9
90–109 15
110–149 24
150–199 38
≥200 46
Systolic blood pressure (mmHg)
<80 58
80–99 53
100–119 43
120–139 34
140–159 24
160–199 10
≥200 0
Initial serum creatinine (mg/dL)
0.0–0.39 1
0.4–0.79 4
0.8–1.19 7
1.2–1.59 10
1.6–1.99 13
0.2–3.99 21
≥4 28
Killip class
I 0
II 20
III 39
IV 59
Cardiac arrest at admission 39
Elevated cardiac markers 14
ST segment deviation 28

Interpretation of Grace Risk Score for In-Hospital Mortality

A nomogram for the probability in-hospital mortality has been developed based on the GRACE score. Shown below is the probability of in-hospital mortality by the corresponding GRACE score value.[1]

Score Probability of in-hospital mortality (%)
≤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%

Grace Risk Score for All-Cause Mortality From Discharge to 6 Months

Calculation of the GRACE Score for All-Cause Mortality From Discharge to 6 Months

The total GRACE risk score is calculated by adding the points assigned to the different variable shown below.[2] The highest total possible score 263.

Variable Points
Age (years)
<40 0
40–49 18
50–59 36
60–69 55
70–79 73
80–89 91
≥90 100
Heart rate (beats/minute)
≤49.9 0
50–69.9 3
70–89.9 9
90–109.9 14
110–149.9 23
150–199.9 35
≥200 43
Systolic blood pressure (mmHg)
<80 24
80–99.9 22
100–119.9 18
120–139.9 14
140–159.9 10
160–199.9 4
≥200 0
Initial serum creatinine (mg/dL)
0.0–0.39 1
0.4–0.79 3
0.8–1.19 5
1.2–1.59 7
1.6–1.99 9
0.2–3.99 15
≥4 20
History of congestive heart failure 24
History of myocardial infarction 12
Elevated cardiac markers 15
ST segment depression 11
No in-hospital PCI 14

Interpretation of the GRACE Score for All-Cause Mortality From Discharge to 6 Months

References

  1. 1.0 1.1 1.2 Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP et al. (2003). "Predictors of hospital mortality in the global registry of acute coronary events.". Arch Intern Med 163 (19): 2345-53. doi:10.1001/archinte.163.19.2345. PMID 14581255.
  2. 2.0 2.1 Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, Van de Werf F et al. (2004). "A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.". JAMA 291 (22): 2727-33. doi:10.1001/jama.291.22.2727. PMID 15187054. Review in: ACP J Club. 2004 Nov-Dec;141(3):80

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