GRACE is considered superior to the TIMI score for mortality prediction as it uses continuous physiological variables and renal function (Creatinine), providing a higher C-statistic (better discrimination).
Killip Classification Reference
Class I
No heart failure.
Class II
Crackles or S3 gallop.
Class III
Pulmonary edema.
Class IV
Cardiogenic shock.
Section 4
Next Steps
Clinical Management
01
Identify "High Risk" (Score >140): Guidelines suggest an early invasive strategy (angiography within 24 hours).
02
Intermediate Risk (109-140): Invasive strategy within 72 hours is reasonable.
03
Review modifiable risk factors and consider renal protection strategies if Creatinine is significantly elevated.
Section 5
Evidence Appraisal
Primary Derivation
Predictors of hospital mortality in the global registry of acute coronary events.
Granger CB et al. • Arch Intern Med.. 2003;n=11,389. Identified the 8 core variables that define the GRACE score across 94 hospitals in 14 countries.
Validation of the GRACE risk score for prediction of death/MI in patients with ACS.
Fox KA et al. • BMJ.. 2006;External validation confirming high performance across diverse clinical populations.
