GRACE ACS Risk and Mortality Calculator
Why Use
Many guidelines recommend more aggressive medical management for patients with a high mortality (or even early invasive management for these patients). Knowing a 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.
When to Use
Patients with known STEMI or unstable angina/NSTEMI, to determine mortality risk.
Formula
Pearls / Pitfalls
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. 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. An alternative version, the mini-GRACE, allows substitutions of Killip class with diuretic usage and/or serum creatinine with a history of renal dysfunction. However, the tool on this platform is the full version and requires both Killip class and serum creatinine.
Advice
Mortality estimate increases as the GRACE score increases. This tool can be used as one factor in determining a course of care and may assist in communication with the patient about their risk. It should not be used in isolation when determining a treatment plan. Ensure high risk patients have guideline-directed care during their hospitalization, as well as appropriate specialist and primary care follow-up upon discharge.
More Information
Score interpretation: Grace Score Range Mortality Risk 0-87 0-2% 88-128 3-10% 129-149 10-20% 150-173 20-30% 174-182 40% 183-190 50% 191-199 60% 200-207 70% 208-218 80% 219-284 90% ≥285 99%