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GRACE Score
Aka: GRACE Score, Global Registry of Acute Coronary Events Score, ACS Risk Model, Acute Coronary Syndrome Risk Model
- See Also
- Chest Pain
- Acute Chest Pain
- Angina Diagnosis
- Cardiac Risk Assessment
- Cardiac Risk Management
- Coronary Risk Stratification of Chest Pain
- Bosner Chest Pain Decision Rule
- Cardiac Risk in Diabetes Score
- Chest Wall Pain Prediction Rule
- Framingham Score
- TIMI Risk
- HEART Score
- Vancouver Chest Pain Rule
- Criteria
- Age
- Score 0: Age <30 years old
- Score 8: Age 30-39 years old
- Score 25: Age 40-49 years old
- Score 41: Age 50-59 years old
- Score 58: Age 60-69 years old
- Score 75: Age 70-79 years old
- Score 91: Age 80-89 years old
- Score 100: Age 90 years old or older
- Heart Rate (HR)
- Score 0: HR <50 bpm
- Score 3: HR 50-69 bpm
- Score 9: HR 70-89 bpm
- Score 15: HR 90-109 bpm
- Score 24: HR 110-149 bpm
- Score 38: HR 150-199 bpm
- Score 46: HR 200 bpm or higher
- Systolic Blood Pressure (SBP)
- Score 58: SBP <80 mmHg
- Score 53: SBP 80-99 mmHg
- Score 43: SBP 100-119 mmHg
- Score 34: SBP 120-139 mmHg
- Score 24: SBP 140-159 mmHg
- Score 10: SBP 160-199 mmHg
- Score 0: SBP 200 mmHg or higher
- Serum Creatinine (sCr)
- Score 1: sCr <0.40 mg/dl
- Score 4: sCr 0.40 - 0.79 mg/dl
- Score 7: sCr 0.80 - 1.19 mg/dl
- Score 10: sCr 1.20 - 1.59 mg/dl
- Score 13: sCr 1.60 - 1.99 mg/dl
- Score 21: sCr 2.00 - 3.99 mg/dl
- Score 28: sCr 4.00 mg/dl or higher
- Congestive Heart Failure (CHF) Killip Class
- Score 0: Killip Class I (No CHF)
- Score 20: Killip Class II (Pulmonary Rales or Jugular Venous Distention or JVD)
- Score 39: Killip Class III (Pulmonary Edema)
- Score 59: Killip Class IV (Cardiogenic Shock)
- Other Risk Factors
- Score 39: Cardiac Arrest at admission (present or absent)
- Score 28: ST segment deviation
- Score 14: Elevated cardiac enzymes or biomarkers (e.g. Troponin I)
- Interpretation: Total GRACE Score (1 to 372 points)
- Score predicts in hospital and 6 month risk of death or Myocardial Infarction
- Non-ST Elevation Acute Coronary Syndrome
- Mortality in hospital
- Score <109: Low risk - Mortality <1%
- Score 109-140: Intermediate risk - Mortality 1-3%
- Score >140: High risk - Mortality >3%
- Mortality at 6 months
- Score <89: Low risk - Mortality <3%
- Score 89-118: Intermediate risk - Mortality 3-8%
- Score >118: High risk - Mortality >8%
- ST-Elevation Acute Coronary Syndrome
- Mortality in hospital
- Score <126: Low risk - Mortality <2%
- Score 126-154: Intermediate risk - Mortality 2-5%
- Score >154: High risk - Mortality >5%
- Mortality at 6 months
- Score <100: Low risk - Mortality <4.5%
- Score 100-127: Intermediate risk - Mortality 4.5-11%
- Score >127: High risk - Mortality >11%
- References
- University Massachusetts Medical School
- http://www.outcomes-umassmed.org/grace/grace_risk_table.aspx
- Resources
- University Massachusetts Medical School
- http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html
- MDCalc
- http://www.mdcalc.com/grace-acs-risk-and-mortality-calculator/
- References
- Fox (2006) BMJ 333(7578):1091 [PubMed]