What is the GRACE score used for?

The GRACE score estimates all-cause mortality risk in patients admitted with acute coronary syndrome (ACS). It is endorsed by the ESC and ACC/AHA guidelines to guide the timing of coronary angiography and intensity of medical therapy — particularly distinguishing patients who need immediate, early, or deferred invasive evaluation.

What are the GRACE risk categories?

GRACE scores are divided into three in-hospital mortality risk tiers: Low risk (score ≤ 108, mortality 140, mortality > 3%). Similar tiers apply for 6-month mortality, with cutoffs at ≤ 88 ( 118 (> 8%).

What is Killip class?

Killip class categorizes heart failure severity in ACS: Class I = no signs of heart failure; Class II = mild HF (rales in lower half of lung fields, S3 gallop, or elevated JVP); Class III = pulmonary edema (rales in more than half of lung fields); Class IV = cardiogenic shock.

Is this tool a substitute for clinical judgment?

No. The GRACE score is a decision-support aid, not a replacement for full clinical assessment. All management decisions must be made by a qualified cardiologist or physician, integrating the score with the patient's complete clinical picture, comorbidities, and patient preferences.

Which creatinine units does this calculator use?

This calculator uses mg/dL, consistent with the original GRACE publication. To convert from µmol/L to mg/dL, divide by 88.4.

Does the GRACE score apply to all ACS subtypes?

Yes. The score was derived from a registry including STEMI, NSTEMI, and unstable angina. It performs well across all three subtypes, though some guidelines primarily reference it in NSTE-ACS (NSTEMI and unstable angina) risk stratification.

GRACE ACS Score

Name: GRACE ACS Score
Availability: InStock
Author: Nham Vu

Enter 8 clinical variables to calculate the GRACE score and estimate in-hospital and 6-month all-cause mortality after acute coronary syndrome.

Patient Variables

Enter all 8 admission values. Score updates instantly.

Age (years)

Heart Rate (bpm)

Systolic Blood Pressure (mmHg)

Serum Creatinine (mg/dL)

Killip Class

Additional Risk Features

Cardiac Arrest at Admission Resuscitated cardiac arrest on presentation

+39

ST-Segment Deviation New ST elevation or depression on presenting ECG

+28

Elevated Cardiac Enzymes / Markers Positive troponin, CK-MB, or other cardiac biomarkers

+14

GRACE Score

—

Enter values above

0Low risk ≤ 108High risk > 140

Mortality Estimates

In-hospital mortality —

6-month all-cause mortality —

Based on GRACE registry derivation cohort. Estimates are approximations; individual risk may vary.

Score Breakdown

Enter patient values to see breakdown.

Management Guidance

Enter values to see risk-stratified guidance.

For informational purposes only. All clinical decisions must be made by a qualified healthcare professional.

Summary

Enter 8 clinical variables to calculate the GRACE score and estimate in-hospital and 6-month all-cause mortality after acute coronary syndrome.

How it works

Enter the patient's age in years.
Record the admission heart rate (beats per minute) and systolic blood pressure (mmHg).
Enter the serum creatinine level in mg/dL.
Select the Killip class that best describes the patient's hemodynamic status.
Check any additional high-risk features: cardiac arrest at admission, ST-segment deviation, and elevated cardiac enzymes.
The GRACE score and mortality estimates update instantly. Review the risk category and management guidance.

Use cases

Triage ACS patients in the emergency department for early invasive vs. conservative management.
Communicate objective risk to patients and families during shared decision-making.
Identify very high-risk NSTEMI patients who benefit from immediate (<2 h) coronary angiography.
Support cardiology trainees in learning GRACE score components and interpretation.
Document risk stratification for audit and quality improvement purposes.
Cross-check bedside manual GRACE calculations for accuracy.
Compare risk across serial admissions for patients with recurrent ACS.
Use alongside TIMI score for complementary risk perspective.

Frequently Asked Questions

Related tools

Cha2ds2 Vasc Score Blood Pressure Category Checker Bmi

Last updated: 2026-05-23 · Reviewed by Nham Vu