Free GRACE Calculator

GRACE Score Calculator: Assessing Mortality Risk in Acute Coronary Syndrome

The GRACE (Global Registry of Acute Coronary Events) risk score is a validated clinical tool designed to estimate the probability of death in patients presenting with acute coronary syndrome (ACS). This calculator leverages data from an international registry that included over 100,000 patients from more than 250 hospitals, initiated in 1999 and continuously refined. It supports two core models: the in-hospital mortality model developed by Granger and the six-month post-admission mortality model developed by Fox. By using the GRACE risk score, clinicians can better stratify patients and guide therapeutic decisions based on short- and long-term risk.

Required Variables

To use the GRACE score calculator, the following eight variables must be collected:

1. Age (years)
2. Heart rate (beats per minute)
3. Systolic blood pressure (mmHg)
4. Creatinine (mg/dL or μmol/L)
5. Killip class (I through IV)
6. Cardiac arrest (presence or absence)
7. ST‑segment deviation (elevation or depression)
8. Elevated cardiac enzymes (e.g., troponin, myoglobin, creatine kinase)

The Killip classification reflects the severity of heart failure during acute myocardial infarction. The table below outlines each class and its associated clinical signs:

Killip class	Signs and symptoms
I	No clinical signs of heart failure
II	Rales/crackles in lungs, elevated jugular venous pressure
III	Acute pulmonary edema
IV	Cardiogenic shock (systolic BP < 90 mmHg, oliguria, cyanosis)

The three binary variables (cardiac arrest, ST deviation, elevated enzymes) are recorded as “present” (1) or “absent” (0).

Calculation Methodology

After entering the required data, the tool calculates the GRACE risk score (total points) using a weighted scoring system. For the in‑hospital mortality model, the total points are determined by the following linear equation (each variable is first converted to points according to specific look‑up tables):

$$\begin{aligned} \text{Total points} = &\; \text{Age points} + \text{Heart rate points} + \text{sBP points} + \text{Creatinine points} \\ &+ \text{Killip points} + (28 \times \text{ST deviation}) \\ &+ (14 \times \text{Elevated enzymes}) + (39 \times \text{Cardiac arrest}) \end{aligned}$$

The same structure applies to the six‑month model but with a different weight set (derived from Fox et al.). Once the total points are obtained, they can be mapped to an estimated mortality rate using published nomograms; this calculator displays both the score and the corresponding predicted mortality.

Point Conversion Tables for Variables

Age Points

Age (years)	Points
< 35	0
35 – 45	$(Age - 35) \times 1.8$
45 – 55	$18 + (Age - 45) \times 1.8$
55 – 65	$36 + (Age - 55) \times 1.8$
65 – 75	$54 + (Age - 65) \times 1.9$
75 – 85	$73 + (Age - 75) \times 1.8$
85 – 90	$91 + (Age - 85) \times 1.8$
≥ 90	100

Heart Rate Points

Heart rate (bpm)	Points
< 50	0
50 – 60	$(HR - 50) \times \frac{3}{10}$
60 – 70	$3 + (HR - 60) \times \frac{3}{10}$
70 – 80	$6 + (HR - 70) \times \frac{3}{10}$
80 – 90	$9 + (HR - 80) \times \frac{3}{10}$
90 – 100	$12 + (HR - 90) \times \frac{3}{10}$
100 – 110	$15 + (HR - 100) \times \frac{3}{10}$
110 – 150	$18 + (HR - 110) \times \frac{12}{40}$
150 – 200	$30 + (HR - 150) \times \frac{16}{50}$
≥ 200	46

Systolic Blood Pressure Points

sBP (mmHg)	Points
< 80	58
80 – 100	$58 - (sBP - 80) \times \frac{10}{20}$
100 – 110	$48 - (sBP - 100) \times \frac{5}{10}$
110 – 120	$43 - (sBP - 110) \times \frac{4}{10}$
120 – 130	$39 - (sBP - 120) \times \frac{5}{10}$
130 – 140	$34 - (sBP - 130) \times \frac{5}{10}$
140 – 150	$29 - (sBP - 140) \times \frac{5}{10}$
150 – 160	$24 - (sBP - 150) \times \frac{5}{10}$
160 – 180	$19 - (sBP - 160) \times \frac{9}{20}$
180 – 200	$10 - (sBP - 180) \times \frac{10}{20}$
≥ 200	0

Creatinine Points (mg/dL)

If the creatinine level is measured in μmol/L, divide the value by 88.4 to convert to mg/dL before using this table.

Creatinine (mg/dL)	Points
< 0.2	$Creatinine \times \frac{1}{0.2}$
0.2 – 0.4	$1 + (Creatinine - 0.2) \times \frac{2}{0.2}$
0.4 – 0.6	$3 + (Creatinine - 0.4) \times \frac{1}{0.2}$
0.6 – 0.8	$4 + (Creatinine - 0.6) \times \frac{2}{0.2}$
0.8 – 1.0	$6 + (Creatinine - 0.8) \times \frac{1}{0.2}$
1.0 – 1.2	$7 + (Creatinine - 1.0) \times \frac{1}{0.2}$
1.2 – 1.4	$8 + (Creatinine - 1.2) \times \frac{2}{0.2}$
1.4 – 1.6	$10 + (Creatinine - 1.4) \times \frac{1}{0.2}$
1.6 – 1.8	$11 + (Creatinine - 1.6) \times \frac{2}{0.2}$
1.8 – 2.0	$13 + (Creatinine - 1.8) \times \frac{1}{0.2}$
2.0 – 3.0	$14 + (Creatinine - 2.0) \times 7$
3.0 – 4.0	$21 + (Creatinine - 3.0) \times 7$
≥ 4.0	28

Killip Class Points

Killip class	Points
I	0
II	20
III	39
IV	59

Dichotomous Variables

Each of the three binary variables contributes its respective coefficient when present (1) and 0 when absent. The coefficients (28 for ST deviation, 14 for elevated cardiac enzymes, 39 for cardiac arrest) are already included in the equation shown in the Calculation Methodology section.

Tables adapted from the GRACE registry data (© 1998‑2014, Center for Outcomes Research, University of Massachusetts Medical School).

Interpreting the Results

The calculator produces a total GRACE risk score for the selected model (in‑hospital or up to six months). Higher scores correspond to greater mortality risk. Additionally, the estimated probability of death is provided. Clinicians can use this information to decide on treatment intensity, revascularization strategies, and post‑discharge follow‑up.

The GRACE risk score has also been updated to version 2.0, which offers predictions over one‑ and three‑year horizons, further supporting long‑term risk stratification.

Important note: This tool is intended for educational and clinical reference purposes only. It does not replace a comprehensive medical evaluation by a qualified healthcare professional. All clinical decisions should be made in consultation with a licensed physician.