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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