GRACE Score
Estimates admission to 6-month mortality for patients with acute coronary syndrome (ACS).
The GRACE Score: Standard for ACS Risk Stratification
The GRACE Score (Global Registry of Acute Coronary Events) is the most validated prognostic tool recommended by international cardiology societies (ESC, AHA/ACC) for risk stratification in patients with Acute Coronary Syndrome (ACS), including STEMI, NSTEMI, and unstable angina.
Why use the GRACE Score?
Unlike other scores (like the TIMI score), the GRACE score integrates continuous variables (age, heart rate, blood pressure, renal function), which gives it much better prognostic accuracy. It reliably estimates:
- In-hospital mortality (the model presented here).
- 6-month mortality (post-discharge).
- It critically guides the timing of coronary angiography (immediate, < 24h, or < 72h) according to the risk classification.
Therapeutic Implications (Invasive Strategy)
In the context of NSTEMI: A GRACE score > 140 (High Risk) mandates an early invasive strategy (coronary angiography within 24 hours). A score between 109 and 140 (Intermediate Risk) justifies an invasive strategy within 72 hours. Conservative management should only be considered in very low-risk patients (< 108).
Interpretation (In-Hospital Mortality)
| GRACE Score | Risk Category | Estimated Mortality |
|---|---|---|
| ≤ 108 points | Low Risk | < 1 % |
| 109 - 140 points | Intermediate Risk | 1 - 3 % |
| > 140 points | High Risk | > 3 % |
References:
1. Granger CB, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(23):2345-53.
[JAMA Network]
2. Collet JP, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021.
[ESC Guidelines]
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