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    GRACE ACS Risk and Mortality Calculator

    Estimates admission-6 month mortality for patients with acute coronary syndrome.
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    Why Use

    Patients with known STEMI or unstable angina/NSTEMI, to determine mortality risk.

    The GRACE Score is a prospectively studied scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality. Like the TIMI Score, it was not designed to assess which patients’ anginal symptoms are due to ACS.

    Note: The GRACE Score was recently improved (GRACE 2.0); MDCalc uses the GRACE 2.0 scoring system, but we will discuss the GRACE model below.

    • The GRACE Score involves 8 variables from history, exam, EKG and laboratory testing. (GRACE 2.0 allows for substitutions of Killip Class for diuretic usage and for serum creatinine with history of renal dysfunction).
    • This score has been validated in >20,000 patients in multiple databases and is extremely well studied and supported.
    • The NICE guidelines recommend the GRACE Score for risk stratification of patients with ACS.
    • Many guidelines recommend more aggressive medical management for patients with a high mortality (or even early invasive management for these patients). Knowing this patient’s risk early may help with management and prognostication/goals of care discussions with patient and family.
    • A patient with some nonspecific features of their workup (history, EKG, troponin) can be more objectively risk stratified for their chest pain, quantify their risk, and potentially lead to shorter hospital stays, fewer inappropriate interventions and more appropriate interventions.
    years
    beats/min
    mm Hg
    mg/dL
    No
    Yes
    No
    Yes
    No
    Yes
    No CHF
    Rales and/or JVD
    Pulmonary edema
    Cardiogenic shock

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    For information regarding risk levels based on Score, the GRACE Research Group offers more information here.

    Content Contributors
    About the Creator
    Dr. Joel Gore
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    Dr. Keith A. A. Fox
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