GRACE Score Calculator for ACS
Risk-stratify acute coronary syndrome (ACS) with the GRACE score, which combines eight variables into an in-hospital mortality risk. Enter age, heart rate, systolic blood pressure and creatinine, choose the Killip class, and tick any of cardiac arrest, ST-segment deviation and elevated cardiac markers. A higher score favours an early invasive strategy.
About the GRACE score
The GRACE (Global Registry of Acute Coronary Events) score estimates mortality risk in acute coronary syndrome to guide the timing and intensity of treatment. Source: Granger CB et al., “Predictors of hospital mortality in the global registry of acute coronary events,” Arch Intern Med 2003;163(19):2345–2353. Compare with the TIMI risk score and HEART score.
How this is calculated
| Variable | Points |
|---|---|
| Age | 0–100 |
| Heart rate | 0–46 |
| Systolic BP | 0–58 |
| Creatinine | 1–28 |
| Killip class (I / II / III / IV) | 0 / 20 / 39 / 59 |
| Cardiac arrest at admission | 39 |
| ST-segment deviation | 28 |
| Elevated cardiac markers | 14 |
Each variable is converted to points via the GRACE 1.0 nomogram (piecewise-linear for the four continuous variables) and summed. In-hospital risk: ≤ 108 low (< 1%), 109–140 intermediate (1–3%), > 140 high (> 3%). Source: Granger CB et al., Arch Intern Med 2003;163(19):2345–2353.
Frequently asked questions
What variables does the GRACE score use?
Eight: age, heart rate, systolic blood pressure, serum creatinine, Killip class (a bedside grading of heart failure), cardiac arrest at admission, ST-segment deviation on the ECG, and elevated cardiac markers such as troponin. Each is converted to points and summed. The four continuous variables (age, heart rate, blood pressure, creatinine) contribute most of the range.
What are the GRACE risk categories?
Using the in-hospital model, a score of 108 or below is low risk (in-hospital mortality under 1%), 109–140 is intermediate (1–3%), and above 140 is high risk (over 3%). Higher-risk patients with non-ST-elevation ACS are those in whom an early invasive strategy is generally recommended. These categories come from the original GRACE (Global Registry of Acute Coronary Events) study, a multinational cohort of patients with acute coronary syndromes enrolled at more than 100 hospitals across 14 countries.
Is this GRACE 1.0 or GRACE 2.0?
This calculator implements the original GRACE (1.0) points model and reports the score and its in-hospital risk category, which is how the score is most often used at the bedside. GRACE 2.0 is a refined non-linear model that outputs precise 1-year and 3-year mortality probabilities; for those exact figures use the official GRACE 2.0 tool. The variables and risk ordering are the same.
What is the Killip class?
Killip class grades heart failure in ACS at the bedside: class I is no signs of failure; class II is rales or a raised jugular venous pressure; class III is acute pulmonary oedema; and class IV is cardiogenic shock. It adds 0, 20, 39 and 59 points respectively, so it strongly influences the score. The classification was first described by Killip and Kimball in 1967 as a simple bedside predictor of mortality after myocardial infarction, based on clinical examination alone rather than any imaging or laboratory test.
When should the GRACE score not be relied on?
The GRACE score is a risk-stratification aid for ACS, not a diagnosis, and assumes ACS has already been diagnosed. It guides the intensity and timing of treatment rather than dictating it, and is used alongside clinical judgement and other tools. This is an educational reference, not medical advice.
This is a reference tool, not a diagnosis or medical advice. Results depend on the laboratory, assay and clinical context, and reference intervals vary between labs and by age and sex — always read your result against the range printed on your own report and discuss it with a qualified healthcare professional.
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