Cardiology Risk score Strong evidence Clinical review pending v1.0.0

GRACE Risk Score — In-hospital Death (ACS)

What is the risk of death during hospitalisation for acute coronary syndrome?

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Presentation

Age

years

Heart rate

beats/min

Systolic blood pressure

mmHg

Serum creatinine

Killip class

I — No heart failure II — Rales and/or raised JVP III — Pulmonary oedema IV — Cardiogenic shock

Findings

Cardiac arrest at admission

ST-segment deviation

Elevated initial cardiac biomarkers

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About this tool

Eight-variable GRACE model estimating in-hospital mortality in acute coronary syndrome, shown both as a direct model probability and as the integer GRACE risk score.

Intended use

Patients hospitalised with acute coronary syndrome (STEMI, NSTEMI or unstable angina).

Outcome

In-hospital death

Time horizon

Index hospitalisation

Derivation population

Patients with ACS in the multinational Global Registry of Acute Coronary Events.

Do not use in

Patients without acute coronary syndrome.

Limitations

Derived in an earlier registry era; contemporary treatment may lower absolute risks.
This is GRACE v1.0; GRACE 2.0 (non-linear, 1- and 3-year outcomes) is not implemented.
Killip class and creatinine are required for this version.

Clinical problems

Chest pain

Evidence

Evidence level

Strong evidence

Derived and externally validated in multiple cohorts (including prospective studies) and incorporated into major clinical guidelines. Methodology

Guideline status

Recommended for prognostic risk stratification in ESC acute coronary syndrome guidelines.

Discrimination

C-statistic 0.83 (derivation), 0.84 (GRACE confirmation cohort) and 0.79 (GUSTO-IIb external cohort).

Geographic applicability

Multinational registry (14 countries).

Evidence summaries for this tool are awaiting independent clinical review. Statistics are shown only where they could be attributed to a specific publication.

References

Original publicationGranger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345-2353. Find on PubMed (opens in a new tab)
Review / updateGRACE Coordinating Center. Methods and formulas used to calculate the GRACE Risk Scores for patients presenting to hospital with an acute coronary syndrome. Center for Outcomes Research, University of Massachusetts Medical School; updated 30 January 2014. Find on PubMed (opens in a new tab)

Version history

Version	Formula	Effective	Reviewer	Changes
v1.0.0	Granger 2003 logistic model and nomogram, per GRACE Coordinating Center methods (2014)	2026-10-03	—	Initial implementation with reference test vectors.

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