GRACE ACS Risk and Mortality Calculator

What's the difference between the GRACE and GRACE 2.0 scores?

GRACE 2.0 is an improved and refined list of outcomes from GRACE; instead of using score ranges to calculate outcomes like in-hospital mortality, we can actually calculate a mortality for every score. People should use GRACE 2.0.

Is there a difference between GRACE 2.0 and Mini-GRACE?

No – they're completely substitutable. We just developed the Mini-GRACE in case a clinician did not know a patient's Killip class or did not have their creatinine available (normally these are available).

What outcome are you using as a cardiologist? In-hospital? 1-year? 3-year?

We use the in-hospital mortality outcome with the GRACE score. It helps us determine disposition in our STEMI patients; those with a score of 130 or higher go to the ICU after catheterization, and those with lower scores can go to our step down unit. We haven't had any bad outcomes and we've also saved a number of ICU beds this way for other patients that need ICU-level care.

We'll also occasionally use the GRACE score on our high risk NSTEMI patients to consider doing early invasive management as opposed to delayed intervention in our NSTEMI patients.

Joel Gore, MD, is a cardiologist at the UMass Memorial Medical Center, where he is also the Director of the Anticoagulation Clinic. He is a professor of Cardiovascular medicine at the University of Massachusetts Medical School and specializes in cardiac prevention. Dr. Gore earned his medical degree from the University of Calgary, and completed residency and fellowship at UMass Memorial Center. He is also board certified in Addiction Psychiatry and Internal Medicine.

Why did you develop the GRACE ACS Risk Score? Was there a clinical experience that inspired you to create this tool for clinicians?

We developed the GRACE ACS risk score because we saw the need for better risk stratification to guide treatment of ACS and to help address the “Treatment-Risk” paradox.

What pearls, pitfalls and/or tips do you have for users of the GRACE ACS Risk Score? Are there cases in which it has been applied, interpreted, or used inappropriately?

It is important to consider not only total risk, but also risk that can be modified (MI risk helps with this).

What recommendations do you have for health care providers once they have applied the GRACE ACS Risk Score? Are there any adjustments or updates you would make to the score given recent changes in medicine?

The GRACE 2.0 (which MDCalc uses) has been shown to be more accurate than the original score.

Other comments? Any new research or papers on this topic in the pipeline?

Yes! We are currently working on developing models to identify modifiable risk and long term risk in ACS patients.

Keith A. A. Fox, MBBS, FRCP, is professor of cardiology at the University of Edinburgh. He was a founding fellow/board member of the European Society of Cardiology and awarded the Silver Medal of the ESC in 2010 for his contributions to cardiology. Professor Fox's major research interests are in the mechanisms and manifestations of acute coronary arterial disease and his work extends from underlying biological mechanisms to in vivo study and clinical trials.