GRACE Score

Predict in-hospital and 6-month mortality in ACS (NSTEMI and unstable angina). Guides decision for early invasive vs conservative strategy.

Indication

Predict in-hospital and 6-month mortality in ACS (NSTEMI and unstable angina). Guides decision for early invasive vs conservative strategy.

Criteria

id: age; label: Age (years); type: options; options: value: 0; label: <40; value: 18; label: 40–49; value: 36; label: 50–59; value: 55; label: 60–69; value: 73; label: 70–79; value: 91; label: ≥80
id: hr; label: Heart rate (bpm); type: options; options: value: 0; label: <70; value: 7; label: 70–89; value: 13; label: 90–109; value: 23; label: 110–149; value: 36; label: 150–199; value: 46; label: ≥200
id: sbp; label: Systolic BP (mmHg); type: options; options: value: 63; label: <80; value: 58; label: 80–99; value: 47; label: 100–119; value: 37; label: 120–139; value: 26; label: 140–159; value: 11; label: 160–199; value: 0; label: ≥200
id: creat; label: Creatinine (mg/dL); type: options; options: value: 2; label: 0–0.39; value: 5; label: 0.4–0.79; value: 8; label: 0.8–1.19; value: 11; label: 1.2–1.59; value: 14; label: 1.6–1.99; value: 23; label: 2.0–3.99; value: 31; label: ≥4
id: arrest; label: Cardiac arrest at admission; type: options; options: value: 43; label: Yes; value: 0; label: No
id: st; label: ST deviation on ECG; type: options; options: value: 30; label: Yes; value: 0; label: No
id: enzymes; label: Elevated cardiac enzymes/troponin; type: options; options: value: 15; label: Yes; value: 0; label: No
id: killip; label: Killip class; type: options; options: value: 0; label: Class I — no CHF; value: 21; label: Class II — rales and/or JVD; value: 43; label: Class III — pulmonary edema; value: 64; label: Class IV — cardiogenic shock

Clinical pearls

GRACE is more accurate than TIMI for risk stratification in NSTEMI
GRACE >140 is an ACC/AHA Class I indication for early invasive strategy within 24 hours
Killip class is the most powerful predictor of in-hospital mortality in the score

Source and review

Fox KA et al. Eur Heart J 2006; ACC/AHA NSTEMI Guidelines 2014. Last reviewed: 2025-01-01