GRACE Calculator

Do you want to know the death rate caused by acute coronary artery syndrome? This article is for you to learn the basic concepts regarding mortality rate calculation by acute coronary artery syndrome.

The GRACE calculator is a diagnostic tool to assess the mortality rate in patients with acute coronary artery syndrome. In addition, there is also a modified version of the GRACE calculator, GRACE 2.0. It is an improved and refined version to evaluate the mortality rate for every score. The GRACE calculator is based on two different formats, including the in-hospital mortality rate by Granger and the 6-month admission mortality rate by Fox.

This article provides all the important details and factors related to the GRACE calculator. Continue reading the article to learn how to use the GRACE calculator.

What is the GRACE risk score?

The GRACE calculator follows the GRACE risk score to evaluate the mortality rate for patients with the acute coronary syndrome. GRACE is an authority that holds the Global Registry of Acute Coronary Events. It is an international authority that compiled data from more than 250 hospitals around the globe. In this project, more than 100,000 patients enrolled with the acute coronary syndrome. These patients followed in-hospital and other long-term consequences. This project started in 1999 and provided precise details to evaluate the risk and mortality in patients with the acute coronary syndrome.

GRACE 2.0 is a modified version of the GRACE calculator. In addition, it helps physicians to evaluate 1 or 3 years prediction of mortality rate for acute coronary syndrome patients. There are multiple other diagnostic calculators to estimate mortality rates in patients suffering from different major cardiac problems.

Which parameters are fundamental for the GRACE calculator to evaluate the mortality rate for acute coronary syndrome patients?

The GRACE calculator follows the summing up of the point score assigned to every parameter. The GRACE calculator is based on the following parameters.

• Age
• Heart rate or pulse (beats/minute)
• Systolic Blood pressure (mmHg)
• Creatinine (μmol/L)
• Cardiac arrest at the time of hospital admission (loss of blood flow)
• ST segment deviation on ECG (depression or elevation)
• Elevated myocardial necrosis enzymes or markers (troponin, myoglobin, creatine kinase)
• Killip class

We will discuss these parameters in the following section to further explain the details related to the GRACE calculator.

How can we calculate the mortality rate following the GRACE risk score?

In this section, we will learn to evaluate the in-hospital mortality for the acute coronary syndrome. This is the equation formula to assess the GRACE risk score.

In-hospital mortality = Killip class + systolic blood pressure + heart rate + age + creatinine level + (28 * ST deviation) + (14 * elevated cardiac enzymes) + (39 * cardiac arrest)

Every parameter is measured in terms of score points. The score points for each parameter are as follows:

Killip class:

Killip class:	Sign and symptoms:	Score point:
I	Not any signs and symptoms of heart failure	0
II	Lung crackles/rales increased jugular venous pressure	20
III	Acute pulmonary edema	39
IV	Systolic blood pressure lesser than 90 mmHg or cardiogenic shock	59

Systolic blood pressure:

Systolic blood pressure (mmHg):	Score points:
Lesser than 80:	58
80-100	58 – (systolic blood pressure – 80) * (10/20)
100-110	48 – (systolic blood pressure – 100) *(5/10)
110- 120	43 – (systolic blood pressure – 110) * (4/10)
120- 130	39 – (systolic blood pressure – 120) * (5/10)
130- 140	34 – (systolic blood pressure – 130) *(5/10)
140- 150	29 – (systolic blood pressure – 140) *(5/10)
150- 160	24 – (systolic blood pressure – 150) *(5/10)
160- 180	19 – (systolic blood pressure – 160) * (9/20)
180- 200	10 – (systolic blood pressure) * (10/20)
Greater than 200	0

Heart rate or pulse:

Heart rate (beats per minute):	Score points:
Lesser than 50:	0
50-60	(Heart rate – 50) * (3/10)
60-70	3 + (Heart rate – 60) * (3/10)
70-80	6 + (Heart rate – 70) * (3/10)
80-90	9 + (Heart rate – 80) * (3/10)
90-100	12 + (Heart rate – 90) * (3/10)
100-110	15 + (Heart rate – 100) * (3/10)
110-150	18 + (Heart rate – 110) * (12/40)
150-200	30 + (Heart rate – 150) * (16/50)
≥200	46

Age:

Age in years:	Score points:
Lesser than 30:	0
30-40	0 + (age – 30) * (17/10)
40-50	17 + (age – 40) * (16/10)
50-60	33 + (age – 50) * (17/10)
60-70	50 + (age – 60) * (17/10)
70-80	67 + (age – 70) * (16/10)
80-90	83 + (age – 80) * (17/10)
Greater than 90:	100

Creatinine level:

Creatinine level (mg/dL):	Score points:
Lesser than 0.2	(Creatinine – 0) * (1/0.2)
0.2 – 0.4	1 + (Creatinine – 0.2) * (2/0.2)
0.4-0.6	3 + (Creatinine – 0.4) * (1/0.2)
0.6-0.8	4 + (Creatinine – 0.6) * (2/0.2)
0.8-1.0	6 + (Creatinine – 0.8) * (1/0.2)
1.0-1.2	7 + (Creatinine – 1.0) * (1/0.2)
1.2-1.4	8 + (Creatinine – 1.2) * (2/0.2)
1.4-1.6	10 + (Creatinine – 1.4) * (1/0.2)
1.6-1.8	11 + (Creatinine – 1.6) * (2/0.2)
1.8-2.0	13 + (Creatinine – 1.8) * (1/0.2)
2.0-3.0	14 + (Creatinine – 2.0) * (7/1)
3.0-4.0	21 + (Creatinine – 3) * (7/1)
Greater than 4:	28

ST deviation on ECG:

• If present = 1
• If absent = 0

Cardiac enzymes:

• If positive = 1
• If negative = 0

Cardiac arrest at the time of admission in hospital:

• If present = 1
• If absent = 0

Grace risk score = sum of the above-mentioned parameters score points according to their condition

Put the score points in the equation formula and get your desired results.

The 6-month estimated mortality rate for the patients with acute coronary syndrome:

1 – 69 points:	< 1%
70 – 90 points:	1 to 2.9%
91 – 110 points:	3 to 3.9%
111 – 130 points:	4 to 5.9%
131 – 150 points:	6 to 11%
151 – 170 points:	12 to 19%
171 – 190 points:	20 to 33%
191 – 263 points:	34 to 54%

Conclusion

The grace calculator is a diagnostic tool to assess the mortality rate in patients with the acute coronary syndrome. This calculator actually follows the grace risk score, which is the sum of score points of different parameters. The GRACE is an international registry that compiled data from multiple hospitals from patients suffering from acute coronary syndrome. In this way, it helps to evaluate the mortality rate for patients suffering from the acute coronary syndrome.

Frequently asked questions (FAQs)