GRACE ACS Risk Score Calculator

Calculate the GRACE score for acute coronary syndrome using age, heart rate, blood pressure, creatinine, Killip class, and presentation features to estimate in-hospital mortality risk.

❤️ Clinical Score📐 GRACE = weighted points from 8 clinical variables🏥 Health

Age (years)

Heart rate (bpm)

Systolic BP (mmHg)

Serum creatinine (mg/dL)

Killip class

Cardiac arrest at admission

ST-segment deviation

Elevated cardiac markers

Please enter valid values.

Formula & Reference

Variable	Symbol	Formula	Units
GRACE ACS Risk Score Calculator	—	GRACE = weighted points from 8 clinical variables	points

Step-by-Step Examples

Example 1

Low Risk

55-year-old, HR 72, SBP 138, creatinine 0.9, Killip I, no arrest, no ST deviation, markers normal.

Age 55 → 41
HR 72 → 9
SBP 138 → 34
Creatinine 0.9 → 7
Killip I → 0, no other features
Total = 91

✓ GRACE 91 — low risk band

Example 2

Intermediate Risk

68-year-old, HR 95, SBP 122, creatinine 1.3, Killip II, ST deviation present, markers elevated.

Age 68 → 58
HR 95 → 15
SBP 122 → 34
Creatinine 1.3 → 10
Killip II → 20
ST deviation → 28, markers → 14
Total = 179

✓ GRACE 179 — high risk band

Example 3

High Risk

82-year-old, HR 118, SBP 92, creatinine 2.4, Killip III, ST deviation, markers elevated.

Age 82 → 91
HR 118 → 24
SBP 92 → 53
Creatinine 2.4 → 21
Killip III → 39
ST deviation → 28, markers → 14
Total = 270

✓ GRACE 270 — high risk band

Real-World Applications

🏥

Invasive Strategy Timing

GRACE is embedded in European and other guidelines as a factor in deciding how urgently to pursue coronary angiography.

📊

Registry-Derived Accuracy

Unlike trial-derived scores, GRACE came from a large multinational registry of unselected real-world ACS patients.

📈

Continuous Variables

Using age, heart rate, blood pressure, and creatinine as continuous inputs gives GRACE finer discrimination than binary-criteria scores.

📚

Cardiology Curricula

GRACE is taught alongside TIMI and HEART as the more quantitatively rigorous of the ACS risk instruments.

Common Mistakes to Avoid

⚠️

Mixing up the in-hospital and 6-month GRACE models

GRACE has separate models for in-hospital and post-discharge mortality, with different coefficients and different thresholds. This tool implements the in-hospital point system.

⚠️

Assigning Killip class loosely

Killip class carries up to 59 points — more than any other single variable except age. Casual assignment badly distorts the total.

⚠️

Reading the mortality estimate as a personal prediction

These figures describe outcomes across large registry populations. No score predicts what will happen to one individual patient.

Frequently Asked Questions

What does GRACE stand for? ▾

Global Registry of Acute Coronary Events — the international observational registry from which the score was derived.

What GRACE score is considered high risk? ▾

For in-hospital mortality, scores above roughly 140 are commonly treated as high risk, 109–140 intermediate, and 108 or below low risk.

Why is Killip class weighted so heavily? ▾

Killip class directly measures the haemodynamic consequences of the infarct, and cardiogenic shock is the single strongest predictor of early death in ACS.

Is GRACE better than TIMI? ▾

GRACE generally shows superior discrimination in comparative studies, largely because it uses continuous rather than dichotomised variables — at the cost of requiring more data.

Does GRACE apply to STEMI as well as NSTEMI? ▾

The registry included the full ACS spectrum, so the score applies across STEMI, NSTEMI, and unstable angina presentations.