GRACE ACS Risk Score Calculator

Total GRACE Score	In-Hospital Mortality
≤ 60	≤ 0.2%
70	0.3%
80	0.4%
90	0.6%
100	0.8%
110	1.1%
120	1.6%
130	2.1%
140	2.9%
150	3.9%
160	5.4%
170	7.3%
180	9.8%
190	13%
200	18%
210	23%
220	29%
230	36%
240	44%
≥ 250	≥ 52%

Risk Tier	GRACE Score	In-Hospital	6-Month
Low	≤ 108	< 1%	< 3%
Intermediate	109–140	1–3%	3–8%
High	> 140	> 3%	> 8%

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Walk-through

How to Use This Calculator

3 steps

1

Enter the eight admission variables

Type the patient's age, heart rate, systolic blood pressure, and serum creatinine (mg/dL) from presentation, choose the Killip class, and check any of cardiac arrest at admission, ST-segment deviation, or elevated cardiac enzymes that apply. The score recalculates on every change.

2

Read the score and mortality estimates

The result card shows the total GRACE score, the estimated in-hospital mortality percentage read from the GRACE registry nomogram, and the 6-month mortality risk band. The interpretation line summarizes all three in one sentence.

3

Check the tier and point breakdown

Use the In-Hospital Mortality and 6-Month Mortality tabs to see the full nomogram and the low / intermediate / high risk-tier cutoffs. The Your Point Breakdown table shows how many points each variable contributed, so you can see what is driving the score.

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Reference

Formula & Methodology

7 formulas

Total GRACE score

Score = Age pts + Heart-rate pts + Systolic-BP pts + Creatinine pts + Killip pts + (Cardiac arrest 39) + (ST deviation 28) + (Elevated enzymes 14)

The GRACE 1.0 model (Granger et al., 2003) assigns integer points to each of eight admission variables and sums them. The three binary items add fixed points when present; the four continuous variables and Killip class use category tables (below). The maximum possible score is about 372.

Age (years) points

<30: 0 | 30–39: 8 | 40–49: 25 | 50–59: 41 | 60–69: 58 | 70–79: 75 | 80–89: 91 | ≥90: 100

Age carries the widest point range of any variable, reflecting its strength as an independent predictor of death in the GRACE registry.

Heart rate (bpm) points

<50: 0 | 50–69: 3 | 70–89: 9 | 90–109: 15 | 110–149: 24 | 150–199: 38 | ≥200: 46

Higher admission heart rate adds more points.

Systolic blood pressure (mmHg) points

<80: 58 | 80–99: 53 | 100–119: 43 | 120–139: 34 | 140–159: 24 | 160–199: 10 | ≥200: 0

The relationship is inverse — lower systolic pressure adds more points, so hypotension at presentation is heavily weighted.

Serum creatinine (mg/dL) points

0–0.39: 1 | 0.40–0.79: 4 | 0.80–1.19: 7 | 1.20–1.59: 10 | 1.60–1.99: 13 | 2.00–3.99: 21 | ≥4.0: 28

Higher creatinine (worse renal function) adds more points.

Killip class points

Class I: 0 | Class II: 20 | Class III: 39 | Class IV: 59

Killip class grades heart-failure severity at presentation, from no signs (I) to cardiogenic shock (IV).

Score to mortality

In-hospital mortality = nomogram lookup(score); 6-month mortality = risk-tier band

The total score maps to in-hospital mortality through the GRACE registry nomogram (0.2% at ≤60 up to ~52% at ≥250). 6-month mortality is reported as an NSTE-ACS risk band (<3% / 3–8% / >8%) rather than a per-score number, because a precise 6-month figure requires a separate post-discharge model.

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High YMYL

Trust, Methodology & Sources

Reviewed by Calculover Editorial Review · Updated 2026-07-22 · 3 sources

Editorial accountability

Author: Quinn Sumner - Editor

Owner: Quinn Sumner - Editorial owner

Reviewer: Calculover Editorial Review - Clinical-source review

Last reviewed: 2026-07-22

Last verified: 2026-07-22

Data effective: 2026-07-22

Methodology

The calculator implements the GRACE 1.0 discrete category-point model (Granger et al., 2003), summing integer points for age, heart rate, systolic blood pressure, creatinine, Killip class, cardiac arrest, ST deviation, and cardiac enzymes, then mapping the total to in-hospital mortality via the GRACE registry nomogram (linear interpolation between published 10-point anchors). Point values were cross-verified across independent reproductions of the original tables.

Assumption: Admission values (age, heart rate, systolic BP, creatinine, Killip class) are entered from the patient's presentation, with creatinine in mg/dL.

Assumption: The NSTE-ACS risk-tier cutoffs are used (low ≤108, intermediate 109–140, high >140).

Assumption: In-hospital mortality is interpolated from the GRACE registry nomogram; 6-month mortality is reported only as a risk band.

Limitations & guidance

This is the GRACE 1.0 admission model; current ESC/ACC guidelines reference the newer GRACE 2.0 continuous model, which can give different point-level estimates.

6-month mortality is reported as a risk band, not a per-score percentage, because a precise 6-month figure requires the separate Eagle/Fox post-discharge model with additional variables.

The score does not account for bleeding risk, comorbidity, frailty, or patient preference and must not be the sole basis of any treatment decision.

Professional guidance: This calculator is for education only and is not medical advice, diagnosis, or treatment. GRACE scores support, but do not replace, the judgment of a licensed clinician and local ACS protocols; treatment decisions require full clinical assessment.

Primary sources

Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events (GRACE) - Granger CB et al., Archives of Internal Medicine, 2003

GRACE ACS Risk and Mortality Calculator - Center for Outcomes Research, University of Massachusetts (MDCalc)

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation - European Society of Cardiology, European Heart Journal

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Glossary

Key Terms Explained

8 terms

GRACE score A points-based risk score derived from the Global Registry of Acute Coronary Events that estimates mortality after acute coronary syndrome from eight admission variables.

Killip class A four-level bedside classification of heart-failure severity in myocardial infarction, from Class I (no failure) to Class IV (cardiogenic shock).

In-hospital mortality The estimated probability of death during the hospital stay for the acute coronary event; read directly from the GRACE score via the registry nomogram.

Cardiac arrest at admission Loss of effective cardiac output requiring resuscitation at or before hospital presentation; when present it adds 39 points to the GRACE score.

ST-segment deviation Elevation or depression of the ST segment on the presenting ECG, a marker of myocardial injury that adds 28 points when present.

Nomogram A reference chart or lookup table that converts a total point score into a predicted probability — here, mapping the GRACE score to in-hospital mortality.

Acute coronary syndrome (ACS) An umbrella term for conditions caused by sudden reduced blood flow to the heart, including unstable angina, NSTEMI, and STEMI.

Risk stratification Sorting patients into low, intermediate, and high risk groups to guide the intensity and timing of treatment, such as when to pursue an invasive strategy.

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Scenarios

Real-World Examples

3 worked examples

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Low-risk NSTE-ACS

52-year-old, stable presentation

Age 52 yr Heart rate 68 bpm Systolic BP 150 mmHg Creatinine 0.9 mg/dL Killip class I Arrest / ST / enzymes none

Points sum to 41 + 3 + 24 + 7 + 0 = 75. A score of 75 sits in the low-risk tier (≤108), with an in-hospital mortality near 0.4% and a 6-month mortality band under 3%. This profile is often compatible with a non-urgent, ischemia-guided strategy at clinician discretion.

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Intermediate-risk NSTEMI

65-year-old with positive troponin

Age 65 yr Heart rate 80 bpm Systolic BP 130 mmHg Creatinine 1.0 mg/dL Killip class I Elevated enzymes yes

Points sum to 58 + 9 + 34 + 7 + 0 + 14 = 122. A score of 122 falls in the intermediate tier (109–140), with an in-hospital mortality near 1.7% and a 6-month band of 3–8%. Guidelines commonly favor an early invasive strategy in this range.

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High-risk ACS

78-year-old with pulmonary edema

Age 78 yr Heart rate 115 bpm Systolic BP 95 mmHg Creatinine 2.1 mg/dL Killip class III ST deviation + enzymes yes

Points sum to 75 + 24 + 53 + 21 + 39 + 28 + 14 = 254. A score of 254 is deep in the high-risk tier (>140); in-hospital mortality is estimated at roughly 52% (the top of the nomogram) with a 6-month band above 8%. This profile generally prompts an early — sometimes urgent — invasive strategy.

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Deep Dive

Understanding the GRACE ACS Risk Score

3 chapters · 4 min read

The GRACE ACS risk score turns eight routine admission measurements into an estimate of how likely a patient with acute coronary syndrome is to die in hospital and over the following months. It is one of the most widely validated risk models in cardiology and helps clinicians decide how aggressively — and how quickly — to treat.

How the GRACE score works

The score was derived from the Global Registry of Acute Coronary Events, a large multinational registry, using multivariable regression to find the admission variables that independently predicted death (Granger et al., Arch Intern Med 2003). Eight variables survived: age, heart rate, systolic blood pressure, serum creatinine, Killip class, cardiac arrest at admission, ST-segment deviation, and elevated cardiac enzymes. Each is assigned integer points, and the total maps to a predicted in-hospital mortality through a registry nomogram.

This calculator implements the transparent GRACE 1.0 point table. Age carries the widest range (0 to 100 points), so a single decade of age can move the total more than most other variables combined.

In-hospital vs 6-month mortality

The admission point table predicts in-hospital mortality precisely, and this tool reports that percentage directly. For 6-month mortality it reports a validated NSTE-ACS risk band (under 3%, 3–8%, or over 8%) rather than a single number. A precise per-score 6-month figure comes from a separate post-discharge model (Eagle 2004 / Fox 2006) that uses different variables, so it cannot be read off the admission total without overstating precision.

How it guides treatment and its limits

Higher GRACE scores support earlier angiography and more intensive therapy in NSTE-ACS. Intermediate and high tiers frequently prompt an early invasive strategy, while low scores may allow an ischemia-guided approach. The score is a decision aid, not a decision: it does not capture bleeding risk, comorbidity, frailty, or patient preference, and it should never be the sole basis for a treatment decision. Current ESC and ACC guidance references the newer GRACE 2.0 continuous model; this page uses GRACE 1.0 for its transparency and reproducibility.

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Questions

Frequently Asked Questions

6 questions

What does GRACE stand for?+

GRACE stands for the Global Registry of Acute Coronary Events — a large multinational registry of patients hospitalized with acute coronary syndrome. The GRACE risk score was derived from that registry to predict death in patients with ACS (Granger et al., Arch Intern Med 2003).

Where does the Killip class come from?+

Killip class is a bedside classification of heart-failure severity at presentation with a myocardial infarction. Class I is no signs of failure, Class II is rales or an elevated jugular venous pressure, Class III is frank pulmonary edema, and Class IV is cardiogenic shock. Higher Killip class carries progressively more GRACE points (0, 20, 39, and 59).

What is the difference between in-hospital and 6-month mortality?+

In-hospital mortality is the estimated risk of death during the index hospitalization for ACS. 6-month mortality extends the horizon to roughly six months after admission. This calculator reports a precise in-hospital percentage from the GRACE 1.0 admission nomogram and reports 6-month mortality as a risk band, because a per-score 6-month figure requires a separate post-discharge model.

Why is age weighted so heavily in the GRACE score?+

Age was one of the strongest independent predictors of death in the GRACE registry, so it carries the widest point range of any variable — from 0 points below age 30 up to 100 points at age 90 or older. A single decade of age can shift the total score more than most other individual variables.

How is the GRACE score used in practice?+

Clinicians use the GRACE score to risk-stratify NSTE-ACS patients and help decide the timing of an invasive strategy. Higher scores — intermediate and high risk — are frequently used to support earlier angiography and more intensive therapy, though the treating clinician's overall assessment always governs the final decision.

What is the difference between GRACE 1.0 and GRACE 2.0?+

GRACE 1.0 (Granger 2003) uses the discrete integer point table implemented here, mapping a total score to mortality via a lookup nomogram. GRACE 2.0 (2014) replaced the point table with a continuous, non-linear statistical model and extended predictions to 1 and 3 years. This tool uses the transparent GRACE 1.0 admission model and presents 6-month mortality as a risk band rather than a fabricated per-score number.

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Admission Variables

GRACE Score & Mortality

Your Point Breakdown

In-Hospital Mortality by GRACE Score

Risk Tiers & 6-Month Mortality

How to Use This Calculator

Enter the eight admission variables

Read the score and mortality estimates

Check the tier and point breakdown

Formula & Methodology

Trust, Methodology & Sources

Key Terms Explained

Real-World Examples

Low-risk NSTE-ACS

Intermediate-risk NSTEMI

High-risk ACS

Understanding the GRACE ACS Risk Score

How the GRACE score works

In-hospital vs 6-month mortality

How it guides treatment and its limits

Frequently Asked Questions

Get a branded PDF of your results

GRACE ACS Risk Score Calculator

Admission Variables

GRACE Score & Mortality

Your Point Breakdown

In-Hospital Mortality by GRACE Score

Risk Tiers & 6-Month Mortality

How to Use This Calculator

Enter the eight admission variables

Read the score and mortality estimates

Check the tier and point breakdown

Formula & Methodology

Trust, Methodology & Sources

Key Terms Explained

Real-World Examples

Understanding the GRACE ACS Risk Score

How the GRACE score works

In-hospital vs 6-month mortality

How it guides treatment and its limits

Frequently Asked Questions

Get a branded PDF of your results

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