GRACE Score

Aka: GRACE Score, Global Registry of Acute Coronary Events Score, ACS Risk Model, Acute Coronary Syndrome Risk Model

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II. Criteria

  1. Age
    1. Score 0: Age <30 years old
    2. Score 8: Age 30-39 years old
    3. Score 25: Age 40-49 years old
    4. Score 41: Age 50-59 years old
    5. Score 58: Age 60-69 years old
    6. Score 75: Age 70-79 years old
    7. Score 91: Age 80-89 years old
    8. Score 100: Age 90 years old or older
  2. Heart Rate (HR)
    1. Score 0: HR <50 bpm
    2. Score 3: HR 50-69 bpm
    3. Score 9: HR 70-89 bpm
    4. Score 15: HR 90-109 bpm
    5. Score 24: HR 110-149 bpm
    6. Score 38: HR 150-199 bpm
    7. Score 46: HR 200 bpm or higher
  3. Systolic Blood Pressure (SBP)
    1. Score 58: SBP <80 mmHg
    2. Score 53: SBP 80-99 mmHg
    3. Score 43: SBP 100-119 mmHg
    4. Score 34: SBP 120-139 mmHg
    5. Score 24: SBP 140-159 mmHg
    6. Score 10: SBP 160-199 mmHg
    7. Score 0: SBP 200 mmHg or higher
  4. Serum Creatinine (sCr)
    1. Score 1: sCr <0.40 mg/dl
    2. Score 4: sCr 0.40 - 0.79 mg/dl
    3. Score 7: sCr 0.80 - 1.19 mg/dl
    4. Score 10: sCr 1.20 - 1.59 mg/dl
    5. Score 13: sCr 1.60 - 1.99 mg/dl
    6. Score 21: sCr 2.00 - 3.99 mg/dl
    7. Score 28: sCr 4.00 mg/dl or higher
  5. Congestive Heart Failure (CHF) Killip Class
    1. Score 0: Killip Class I (No CHF)
    2. Score 20: Killip Class II (Pulmonary Rales or Jugular Venous Distention or JVD)
    3. Score 39: Killip Class III (Pulmonary Edema)
    4. Score 59: Killip Class IV (Cardiogenic Shock)
  6. Other Risk Factors
    1. Score 39: Cardiac Arrest at admission (present or absent)
    2. Score 28: ST Segment deviation
    3. Score 14: Elevated cardiac enzymes or biomarkers (e.g. Troponin I)

III. Interpretation: Total GRACE Score (1 to 372 points)

  1. Score predicts in hospital and 6 month risk of death or Myocardial Infarction
  2. Non-ST Elevation Acute Coronary Syndrome
    1. Mortality in hospital
      1. Score <109: Low risk - Mortality <1%
      2. Score 109-140: Intermediate risk - Mortality 1-3%
      3. Score >140: High risk - Mortality >3%
    2. Mortality at 6 months
      1. Score <89: Low risk - Mortality <3%
      2. Score 89-118: Intermediate risk - Mortality 3-8%
      3. Score >118: High risk - Mortality >8%
  3. ST-Elevation Acute Coronary Syndrome
    1. Mortality in hospital
      1. Score <126: Low risk - Mortality <2%
      2. Score 126-154: Intermediate risk - Mortality 2-5%
      3. Score >154: High risk - Mortality >5%
    2. Mortality at 6 months
      1. Score <100: Low risk - Mortality <4.5%
      2. Score 100-127: Intermediate risk - Mortality 4.5-11%
      3. Score >127: High risk - Mortality >11%
  4. References
    1. University Massachusetts Medical School
      1. http://www.outcomes-umassmed.org/grace/grace_risk_table.aspx

IV. Resources

  1. University Massachusetts Medical School
    1. http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html
  2. MDCalc
    1. http://www.mdcalc.com/grace-acs-risk-and-mortality-calculator/

V. References

  1. Fox (2006) BMJ 333(7578):1091 [PubMed]

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