GRACE Calculator
Table of contents
What is the GRACE risk score?How to use the GRACE calculator?How to calculate the GRACE risk score for ACS?FAQsGRACE calculator is a tool that estimates the probability of death in acute coronary syndrome (ACS) patients.
Our GRACE score calculator supports two different models: in-hospital deaths by Granger, and admission-6-months mortality by Fox.
Follow the article below for the GRACE score definition and detailed explanation. ⤵️
What is the GRACE risk score?
GRACE stands for The Global Registry of Acute Coronary Events. GRACE was an international registry, gathering data from over 250 hospitals all around the world. The project enrolled over 100,000 patients with acute coronary syndrome and followed their in-hospital and long-term outcomes. 🌎
This cooperation started in 1999 and resulted in an ACS calculator for assessing the risk and mortality among this kind of patient.
GRACE risk score 2.0 is an improved version of the GRACE score. It allows clinicians to make decisions based on 1- or 3-year predictions.
You may also check another reliable tool for calculating mortality rates in patients with unstable angina or NSTEMI — the TIMI score calculator.
How to use the GRACE calculator?
Our ACS risk calculator consists of 8 variables, including 4 that require numerical input:
- Age given in years;
- Pulse given in beats per minute;
- Systolic blood pressure; and
- Creatinine given in mg/dL or μmol/L.
You will also need to know the Killip Class. The following table describes the signs/symptoms of each class.
Killip class | Signs/symptoms |
|---|---|
I | No signs or symptoms of heart failure |
II | Lungs rales/crackles, elevated jugular venous pressure |
III | Acute pulmonary edema |
IV | Cardiogenic shock/systolic blood pressure <90 mmHg/ signs of vasoconstriction (oligouria, cyanosis, etc.) |
Your next step will consist of evaluating the presence or absence of the following abnormalities:
- Cardiac arrest (loss of blood flow);
- Segment ST deviation (elevation or depression); and
- Elevated cardiac enzymes, such as myoglobin, troponin or creatine kinase.
Your result will include the GRACE cardiovascular risk score calculated in two separate models:
- In hospital
- Up to 6 months after admission
You'll also see predicted mortality rates.
You've already got your results — how about discovering something new? Compute the cardiovascular risk with the CVD calculator or the HEART score calculator. ❤️
How to calculate the GRACE risk score for ACS?
Here, we present and explain charts for the In-hospital mortality. For other charts and different models, visit .
Our GRACE risk score calculator online uses the following equation:
In-hospital mortality = Killip class + sBP + Heart rate + Age + Creatinine + (28 × ST deviation) + (14 × Elevated cardiac enzymes) + (39 × Cardiac arrest),
where each variable is converted into points using the following tables:
- Age
Age (years) | Number of points |
|---|---|
<35 | 0 |
35-45 | (Age-35)×(1.8) |
45-55 | 18 + (Age-45)×(1.8) |
55-65 | 36 + (Age-55)×(1.8) |
65-75 | 54 + (Age-65)×(1.9) |
75-85 | 73 + (Age-75)×(1.8) |
85-90 | 91 + (Age-85)×(1.8) |
≥90 | 100 |
- Heart rate / Pulse
HR (bpm) | Number of points |
|---|---|
<50 | 0 |
50-60 | (HR-50)×(3/10) |
60-70 | 3 + (HR-60)×(3/10) |
70-80 | 6 + (HR-70)×(3/10) |
80-90 | 9 + (HR-80)×(3/10) |
90-100 | 12 + (HR-90)×(3/10) |
100-110 | 15 + (HR-100)×(3/10) |
110-150 | 18 + (HR-110)×(12/40) |
150-200 | 30 + (HR-150)×(16/50) |
≥200 | 46 |
- sBP - systolic blood pressure
sBP (mmHg) | Number of points |
|---|---|
<80 | 58 |
80-100 | 58 - (sBP-80)×(10/20) |
100-110 | 48 - (sBP-100)×(5/10) |
110-120 | 43 - (sBP-110)×(4/10) |
120-130 | 39 - (sBP-120)×(5/10) |
130-140 | 34 - (sBP-130)×(5/10) |
140-150 | 29 - (sBP-140)×(5/10) |
150-160 | 24 - (sBP-150)×(5/10) |
160-180 | 19 - (sBP-160)×(9/20) |
180-200 | 10 - (sBP-180)×(10/20) |
≥200 | 0 |
- Creatinine
Creatinine mg/dL | Number of points |
|---|---|
<0.2 | (Creatinine-0)×(1/0.2) |
0.2-0.4 | 1 + (Creatinine-0.2)×(2/0.2) |
0.4-0.6 | 3 + (Creatinine-0.4)×(1/0.2) |
0.6-0.8 | 4 + (Creatinine-0.6)×(2/0.2) |
0.8-1.0 | 6 + (Creatinine-0.8)×(1/0.2) |
1.0-1.2 | 7 + (Creatinine-1.0)×(1/0.2) |
1.2-1.4 | 8 + (Creatinine-1.2)×(2/0.2) |
1.4-1.6 | 10 + (Creatinine-1.4)×(1/0.2) |
1.6-1.8 | 11 + (Creatinine-1.6)×(2/0.2) |
1.8-2.0 | 13 + (Creatinine-1.8)×(1/0.2) |
2.0-3.0 | 14 + (Creatinine-2.0)×(7/1) |
3.0-4.0 | 21 + (Creatinine-3.0)×(7/1) |
≥4.0 | 28 |
- Killip class
Class | Number of points |
|---|---|
I class | 0 |
II class | 20 |
III class | 39 |
IV class | 59 |
-
ST deviation, Elevated cardiac enzymes, Cardiac arrest
All three variables can take the following values:
- If present: 1
- If absent: 0
Citation for the above tables: Copyright 1998-2014, Center for Outcomes Research, University of
Massachusetts Medical School.
Disclaimer: This calculator cannot be a substitute for medical advice and shouldn't be the single source for any medical decision.
What is the GRACE score in ACS?
The GRACE (Global Registry of Acute Coronary Events) score assesses the risk of in-hospital mortality of patients with ACS (Acute Coronary Syndrome).
It is used by clinicians to understand their patients' prospects and make the best decisions based on this 1-3-year prediction.
What happens in ACS?
Acute coronary syndrome corresponds to conditions that cause a sudden and severely reduced blood supply to the heart. Under this spectrum fall heart attacks and unstable angina.
How do you calculate the risk of death for ACS?
To calculate the mortality risk for ACS with the GRACE score, follow these steps:
-
Determine your patient's heart rate.
-
Measure the systolic blood pressure.
-
Find the concentration of creatinine in your patient's blood.
-
Determine the Killip class for your patient.
-
Assess the presence of cardiac arrest, segment ST deviation, and elevated cardiac enzymes for your patient.
-
Along with age, enter all values in the formula:
In-hospital mortality = Killip class + sBP + Heart rate + Age + Creatinine + (28 × ST deviation) + (14 × Elevated cardiac enzymes) + (39 × Cardiac arest) -
That's it! Now, you have a reliable prediction of the mortality risk of your ACS patient.
What are the risk factors for developing ACS?
The main risk factors for ACS are high blood pressure, smoking, diabetes, high fat levels, obesity, poor diet, lack of physical activity, and a family history of this health condition.