GRACE

ACS RISK SCORE

University of Edinburgh

ACS RISK SCORE

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ACS RISK SCORE

FAQ

What does this do?

The GRACE 2.0 ACS Risk Calculator is a tool to help clinicians assess the future risk of death or myocardial infarction (MI), as a guide to treatment options, in a patient with an acute coronary syndrome (ACS). It includes clinical findings at admission that have been shown to have predictive power for adverse events.

Visit www.outcomes-umassmed.org/GRACE/bibliography.aspx for a complete bibliography.

These factors include age, heart rate, systolic blood pressure, renal function, congestive heart failure, ST-segment deviation, cardiac arrest and elevated biomarkers, which together provide more than 90% of the accuracy of the complete multivariable prediction model. Outputs are given in terms of probability of dying (as a percentage) while in hospital, and at 6 months and 1 and 3 years after admission. The combined risk of death or MI at 1 year is also given. The GRACE score at 6 months is also provided as guidelines have categorized patients into low (≤108 GRACE score), medium (109–140 GRACE score) and high risk (>140 GRACE score)5.

Why would I use it?

Risk calculators are designed to integrate important risk factors. The GRACE 2.0 ACS Risk Calculator can provide clinicians with a robust risk of death or death/MI for the patient presenting with ACS, to help decide whether intensive and invasive therapies are appropriate. The final decision on choices of treatment is a clinical decision based on all information available to the clinician and the particular situation of the individual patient. The GRACE Risk Score has been extensively and independently validated (www.outcomes-umassmed.org/GRACE/). The current updated version of the calculator provides more accurate non-linear computations and an updated interface for mobile devices.

How do I enter data?

To calculate the GRACE risk for any patient with documented or suspected ACS, enter the patient data by selecting from the ranges given or by using the yes/no toggle switches. Press "Calculate" to obtain risk of event probabilities, or "Reset" to clear all entered data.

On the results screen, use "Edit input" to change individual parameters for the same patient, or "New calculation" to reset the calculator and start over.

What is CHF/Killip?

Killip is a classification of congestive heart failure (CHF) that independently predicts mortality in patients with MI. For the purposes of the calculator it includes prior history or current CHF.

The Killip classification:

  1. No clinical sign of CHF
  2. Presence of rales (crackles) in the lungs, raised jugular venous pressure, or third heart sound (S3 gallop)
  3. Acute pulmonary oedema
  4. Cardiogenic shock

What are the creatinine units?

Creatinine values are displayed in both US and SI units (mg dL-1 and μmol L-1, respectively).

What is troponin?

Troponin is a protein found in heart cells that is released into the bloodstream following cardiac damage. Elevated troponin in the bloodstream on admission is a strong predictor of mortality and infarct size. If troponin data are not available then cardiac biomarkers of myocardial necrosis (sometimes known as “cardiac enzymes”, for example CK-MB or CK) may be substituted.

What do the results mean?

The results are given first as a probability (expressed as a percentage) of either death alone, or death/MI, occurring up to given time points after admission. The original GRACE score is also provided for 6-month results.

Why is a range quoted?

Because of differences in the way the 6-month and 1-year probabilities are calculated (see “What are its limitations?”), and to reflect the differences in original risk populations, a range of probabilities may be quoted.

Who made this?

The updated calculator is derived from the original GRACE score. The work on the updated calculator was supported by the British Heart Foundation, the Chief Scientist in Scotland and an educational grant from AstraZeneca to the University of Edinburgh (chair of the GRACE Advisory Committee, Professor Keith A A Fox at the University of Edinburgh). Gordon FitzGerald and Fred Anderson, University of Massachusetts Medical School, analysed the GRACE population risk factors and created the algorithms.