What is the GRACE score used for?

The GRACE score estimates all-cause in-hospital and 6-month mortality for patients with acute coronary syndrome. ESC and ACC/AHA guidelines use it to categorize risk as low, intermediate, or high and to determine the appropriate timing of coronary angiography — immediate (< 2 h), early (< 24 h), or deferred.

What are the GRACE risk categories?

In-hospital mortality tiers: Low (score ≤ 108, 140, > 3%). Six-month mortality tiers: Low (score ≤ 88, 118, > 8%).

What is Killip class?

Killip class grades heart failure severity in ACS: I = no HF signs; II = mild HF (rales in lower lung fields, S3, or elevated JVP); III = pulmonary edema (rales in > half of lung fields); IV = cardiogenic shock (hypotension + end-organ hypoperfusion).

Which creatinine unit does this calculator use?

This calculator uses mg/dL, matching the original GRACE publication. To convert from µmol/L divide by 88.4 (e.g., 97 µmol/L ÷ 88.4 ≈ 1.1 mg/dL).

Does the GRACE score apply to STEMI?

Yes. The score was derived from a registry including STEMI, NSTEMI, and unstable angina, and performs well across all three subtypes. ESC STEMI guidelines primarily reference it for post-discharge risk stratification.

Is this tool a clinical decision support replacement?

No. The GRACE score is a decision-support aid only. All management decisions must be made by a qualified cardiologist or physician, integrating the score with the complete clinical picture, patient comorbidities, and patient preferences.

GRACE Score Calculator

Enter 8 clinical variables to calculate the GRACE score and get in-hospital and 6-month all-cause mortality estimates for 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 pts

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

+28 pts

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

+14 pts

GRACE Score

—

Enter values above

0 Low ≤ 108 High > 140

Mortality Estimates

In-hospital mortality —

6-month all-cause mortality —

Estimates based on GRACE registry derivation cohort (Fox et al., BMJ 2006). 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

The GRACE (Global Registry of Acute Coronary Events) score is a validated clinical risk model for patients admitted with acute coronary syndrome (ACS), including STEMI, NSTEMI, and unstable angina. It combines eight independently weighted variables — age, heart rate, systolic blood pressure, serum creatinine, Killip class at presentation, and three binary risk features (cardiac arrest on admission, ST-segment deviation, and raised cardiac markers) — to produce a numerical score linked to in-hospital and 6-month all-cause mortality. Endorsed by ESC and ACC/AHA guidelines, the score helps clinicians determine the urgency of coronary angiography and intensity of medical management.

How it works

Enter the patient's age in years.
Record the admission heart rate in beats per minute and systolic blood pressure in mmHg.
Enter the serum creatinine in mg/dL (divide µmol/L by 88.4 to convert).
Select the Killip class that best reflects the patient's heart failure status on admission.
Check any high-risk features present: cardiac arrest at admission, new ST-segment deviation, and elevated cardiac biomarkers.
The GRACE score and mortality estimates calculate instantly. Review the risk tier and management guidance below.

Use cases

Risk-stratify ACS patients in the emergency department to guide early invasive vs. conservative management.
Identify very high-risk NSTEMI patients requiring immediate coronary angiography (within 2 hours).
Support shared decision-making with patients and families using objective mortality estimates.
Verify manual GRACE calculations performed at the bedside.
Document standardized risk stratification for cardiology audits and quality improvement.
Educate cardiology trainees on GRACE score components and clinical thresholds.
Compare risk across serial ACS admissions for patients with recurrent disease.
Use alongside TIMI score for complementary risk perspectives.

Frequently Asked Questions

Last updated: 2026-09-30 · Reviewed by Nham Vu