GRACE Score Calculator — ACS In-Hospital Mortality Risk
Calculate the GRACE (Global Registry of Acute Coronary Events) score for ACS patients: enter age, heart rate, blood pressure, creatinine, Killip class, and key clinical findings to estimate in-hospital mortality risk.
years
bpm
mmHg
mg/dL
Killip class (heart failure signs)
Cardiac arrest at admission
ST-segment deviation on ECG
Elevated cardiac enzymes / markers (troponin or CK-MB)
In-hospital mortality: ≤108 = low (<1%), 109–140 = intermediate (1–3%), >140 = high (>3%)
- 1
Age + HR + SBP points
58 + 9 + 34 = 101 - 2
Creatinine + Killip class points
7 + 0 = 7 - 3
Clinical flag points (arrest + ST + enzymes)
0 + 0 + 0 = 0 - 4
Total GRACE Score
101 + 7 + 0 = 108≤108 = low risk (<1%), 109–140 = intermediate (1–3%), >140 = high (>3%) in-hospital mortality.
How does this calculator work?
GRACE score = points for age + HR + SBP + creatinine + Killip class + cardiac arrest + ST deviation + elevated enzymes (range 0–372). Score ≤108 = low in-hospital mortality (<1%), 109–140 = intermediate (1–3%), >140 = high (>3%). From Granger et al., JAMA 2003. For clinical education and research.
Formula
How this is calculated
The GRACE score was derived from the Global Registry of Acute Coronary Events, a large multinational registry of patients hospitalised with ACS. Published by Granger et al. in 2003 (JAMA), it assigns points to eight variables measured on admission: age (0–100 points), heart rate (0–46), systolic blood pressure (0–58, higher for lower BP reflecting haemodynamic compromise), serum creatinine (1–28, reflecting renal function), Killip heart-failure class (0–59), cardiac arrest at admission (+39), ST-segment deviation on ECG (+28), and elevated cardiac biomarkers such as troponin (+14). The sum estimates in-hospital mortality: ≤108 corresponds to <1% risk (low), 109–140 to 1–3% (intermediate), and >140 to >3% (high).
The model captures the dominant risk factors in ACS: haemodynamic instability (low BP, tachycardia, high Killip class) drives the largest point contributions, while age and renal impairment reflect baseline frailty. A cardiac arrest at presentation carries a flat 39-point penalty because it dramatically alters prognosis regardless of other values. ST deviation and biomarker elevation confirm ongoing myocardial injury.
The GRACE 2.0 score (Fox et al., BMJ Open 2014) uses a revised regression model for 6-month mortality and re-hospitalisation after discharge, and continuous (non-banded) coefficients. This calculator implements the original GRACE point-based system for in-hospital mortality, which remains widely used and is the version printed on most bedside reference cards. Values are from the 2003 validation cohort; contemporary ACS mortality is lower due to advances in reperfusion and pharmacotherapy.
Frequently asked questions
GRACE 1.0 (2003) uses banded point allocations for in-hospital mortality. GRACE 2.0 (2014) uses a logistic regression model with continuous inputs, predicting 6-month mortality and 1-year re-hospitalisation after discharge. GRACE 2.0 is recommended by the ESC for post-discharge risk stratification; this calculator implements the original 1.0 banded system for in-hospital mortality.
Divide µmol/L by 88.4 to get mg/dL. For example, 90 µmol/L ÷ 88.4 = 1.02 mg/dL. Alternatively, multiply mg/dL by 88.4 to convert back to µmol/L. The normal range is roughly 0.7–1.2 mg/dL (62–106 µmol/L) for adults.
ESC and ACC/AHA guidelines recommend invasive strategy timing based partly on GRACE score. An intermediate or high GRACE score in NSTEMI generally supports early (within 24 hours) invasive assessment. However, clinical decision-making also incorporates ongoing ischaemia, haemodynamic instability, bleeding risk, comorbidities, and patient preference.
Also known as
TG we-Calculate Editorial Team. (2026). GRACE Score Calculator — ACS In-Hospital Mortality Risk [Online calculator]. TG we-Calculate. https://we-calculate.com/calculator/grace-calculator
TG we-Calculate Editorial Team. "GRACE Score Calculator — ACS In-Hospital Mortality Risk." TG we-Calculate. 2026. https://we-calculate.com/calculator/grace-calculator.
TG we-Calculate Editorial Team, "GRACE Score Calculator — ACS In-Hospital Mortality Risk," TG we-Calculate, 2026. [Online]. Available: https://we-calculate.com/calculator/grace-calculator
@misc{wecalculate_grace_calculator, title = {GRACE Score Calculator — ACS In-Hospital Mortality Risk}, author = {{TG we-Calculate Editorial Team}}, howpublished = {\url{https://we-calculate.com/calculator/grace-calculator}}, year = {2026}, note = {TG we-Calculate} }
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