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History of the GRACE Risk Score

One of the major achievements of the main GRACE Programme was development of a clinical risk prediction tool for estimating the cumulative risk of death and death or myocardial infarction to aid triage and management of patients with ACS. Known as the GRACE Risk Score, this model was originally developed to estimate the risk of in-hospital mortality for patients presenting to hospital with a suspected ACS.2 The model was further developed to include prediction of mortality 6 months post discharge.3 Following recognition that there was a requirement for a comprehensive risk model to predict not only death, but death or myocardial infarction for up to a period of 6 months after hospital discharge, the GRACE Risk Score was again further developed.4 8 clinical variables were involved in calculating the risk for death, and death or myocardial infarction from admission to hospital to 6 months after discharge. It is this version which has been most widely applied in clinical settings for estimation of risk for patients with ACS.

8 Clinical Variables

  • Age (years)
  • Heart Rate (beats per minute)
  • Systolic blood pressure (mmHg)
  • Creatinine (mg/dL or μmol/L)
  • Congestive Heart Failure (Killip)
  • Cardiac arrest at admission
  • ST-segment deviation
  • Elevated cardiac enzymes/biomarkers

The 6 month post discharge model is still available online here.