GRACE Calculator

What Is the GRACE Score?

The Global Registry of Acute Coronary Events (GRACE) score estimates mortality risk in patients with acute coronary syndrome (ACS). It combines age, vital signs, renal function, heart failure severity, and high-risk clinical findings to produce separate in-hospital and 6-month risk estimates. For stroke risk in atrial fibrillation, see the CHA2DS2-VASc Calculator.

Variables Used in the Score

The calculator uses admission age, heart rate, systolic blood pressure, serum creatinine, Killip class, and three binary findings: cardiac arrest, ST-segment deviation, and elevated cardiac enzymes. Age, heart rate, blood pressure, and creatinine are converted to points using validated piecewise linear tables.

In-Hospital vs 6-Month Models

Both models share the same base points for age, heart rate, systolic pressure, creatinine, and Killip class. Cardiac arrest, ST deviation, and elevated enzymes carry different weights in the in-hospital model (39, 28, and 14 points) versus the 6-month model (30, 17, and 13 points).

Risk Stratification

For NSTEMI and unstable angina, in-hospital scores below 109 suggest low risk (mortality below 1%), 109 to 140 intermediate risk, and above 140 high risk. Six-month cutoffs are below 89, 89 to 118, and above 118. STEMI uses higher thresholds because baseline mortality is greater.