GRACE 2.0 ACS Risk Stratification • In-Hospital & 6-Month Mortality
Age
yearsHeart Rate
bpmSystolic BP
mmHgCreatinine
mg/dLReady for Risk Analysis
Complete vitals and clinical findings to calculate GRACE 2.0 mortality risk.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
Patients with a confirmed or suspected diagnosis of Acute Coronary Syndrome (STEMI, NSTEMI, or UA).
To predict in-hospital and 6-month mortality and major cardiac events.
To guide the intensity of medical and invasive therapy (e.g., timing of catheterization).
How it Works
Variables
Age (Continuous variable)
Heart Rate (Continuous variable)
Systolic Blood Pressure (Continuous variable)
Creatinine Level (Reflects renal clearance)
Killip Class (Degree of heart failure)
Cardiac Arrest at Admission
ST-Segment Deviation
Elevated Cardiac Biomarkers
In-Hospital Mortality Risk Thresholds
| Score ≤ 108 | < 1% (Low Risk) |
| Score 109–140 | 1–3% (Intermediate Risk) |
| Score > 140 | > 3% (High Risk) |
Clinical Pearls
GRACE vs. TIMI
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. |
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.
The Evidence
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.
Last Comprehensive Review: 2026-07-17