GRACE ACS Risk

Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the Global Registry of Acute Coronary Events. Derived an eight-variable model (age, heart rate, systolic BP, creatinine, Killip class, cardiac arrest at admission, ST-segment deviation, raised cardiac markers) predicting in-hospital death across the ACS spectrum.

Fox KAA, FitzGerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score (GRACE 2.0). Refit the model with non-linear terms and extended predictions to 1–3 years.

ESC NSTE-ACS guidelines recommend GRACE risk assessment to guide the timing of invasive angiography (e.g. a GRACE score > 140 favours an early invasive strategy) and discharge planning. In-hospital risk categories: low ≤ 108, intermediate 109–140, high > 140. The continuous GRACE 2.0 web/app calculator gives better-calibrated individual estimates than the points version.