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.

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.

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.

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. 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