GRACE Score

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

1. See Also
   1. Chest Pain
   2. Acute Chest Pain
   3. Angina Diagnosis
   4. Cardiac Risk Assessment
   5. Cardiac Risk Management
   6. Coronary Risk Stratification of Chest Pain
   7. Bosner Chest Pain Decision Rule
   8. Cardiac Risk in Diabetes Score
   9. Chest Wall Pain Prediction Rule
   10. Framingham Score
   11. TIMI Risk
   12. HEART Score
   13. Vancouver Chest Pain Rule
2. 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)
3. 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
4. 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/
5. References
   1. Fox (2006) BMJ 333(7578):1091 [PubMed]