What is the GRACE score?

GRACE (Global Registry of Acute Coronary Events) is a risk model that estimates mortality after an acute coronary syndrome. It combines age, heart rate, systolic blood pressure, creatinine, Killip class, cardiac arrest at admission, ST-segment deviation, and elevated cardiac markers into a points total.

How is the GRACE risk band interpreted?

For in-hospital mortality, a score of 108 or below is low risk (under 1%), 109 to 140 is intermediate (1 to 3%), and above 140 is high risk (over 3%). High-risk patients generally benefit from an early invasive strategy within 24 hours.

What is the Killip class?

Killip class describes heart-failure severity in ACS: I = no signs of failure, II = crackles or a third heart sound, III = frank pulmonary oedema, IV = cardiogenic shock. Higher classes add more points and signal worse prognosis.

Does this implement GRACE 1.0 or 2.0?

This tool uses the validated GRACE 1.0 points algorithm for in-hospital mortality, which sums integer points from the original nomogram. GRACE 2.0 replaces the linear points with non-linear functions and is typically delivered as a proprietary calculator.

Is my data stored anywhere?

No. The calculation runs entirely in your browser and nothing you enter is transmitted or saved on any server.

GRACE ACS Outcome Score

The GRACE score is one of the most rigorously validated tools for estimating mortality after an acute coronary syndrome. It informs whether a patient should receive an early invasive strategy and supports objective triage in chest-pain pathways.

How it works

Eight variables each contribute points from the GRACE 1.0 nomogram, and the points are summed into a total (roughly 0 to 280 for in-hospital mortality):

Age — points rise steeply with each decade (about 0 under 30 up to roughly 100 at 90+).
Heart rate — more points as the rate climbs above 70 beats per minute.
Systolic blood pressure — more points as pressure falls below 120 mmHg.
Creatinine — more points as renal function worsens.
Killip class — I, II, III, or IV adds increasing points for heart failure.
Cardiac arrest at admission — adds a fixed block of points.
ST-segment deviation — adds points.
Elevated cardiac markers — adds points.

The total maps to an in-hospital mortality band:

≤ 108 — low risk (under 1%).
109–140 — intermediate risk (1–3%).
> 140 — high risk (over 3%): consider an early invasive strategy.

Example and notes

A 75-year-old with a heart rate of 90, systolic of 110 mmHg, creatinine of 1.2 mg/dL, Killip class II, ST deviation, and raised troponin accumulates a high total, placing them firmly in the high-risk band.

This calculator implements the integer-point GRACE 1.0 algorithm. The newer GRACE 2.0 uses non-linear functions and a slightly different output but a similar clinical interpretation. The score is a triage aid, not a substitute for the full clinical picture.