GRACE ACS Risk

Acute coronary syndrome — in-hospital mortality from 8 admission variables

Age (years)

Heart rate (beats/min)

Systolic blood pressure (mmHg)

Serum creatinine

Killip class

I — no heart failure

II — rales / raised JVP / S3

III — frank pulmonary oedema

IV — cardiogenic shock

Cardiac arrest at admission

ST-segment deviation on ECG

Elevated cardiac biomarkers (troponin/CK-MB)

Enter age, heart rate, systolic BP and creatinine

Evidence

Original publication

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.

Archives of Internal Medicine, 2003

Open source

Validation

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.

BMJ Open, 2014

Open source

Guideline

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.

Last reviewed: 2026-09

Report an error in this calculator

MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.