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GRACE Calculator

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Calculate the GRACE risk score for acute coronary syndrome from age, vitals, creatinine, and Killip class to estimate in-hospital and 6-month mortality risk.

Reviewed by the thecalcu.com team · Last updated July 31, 2026

Age
years
Heart Rate
bpm
Systolic BP
mmHg
Serum Creatinine
mg/dL
Killip Class

Cardiac Arrest at Admission

ST-Segment Deviation

Elevated Cardiac Enzymes

GRACE Score

0

In-Hospital Mortality Risk

—

6-Month Mortality Risk

—

Not a substitute for clinical judgment. Referral for early invasive strategy and cardiac catheterization must be decided by a qualified cardiologist weighing this score alongside the full clinical picture.

What is a GRACE Score?

The GRACE Calculator computes the GRACE (Global Registry of Acute Coronary Events) risk score, one of the most widely validated tools for estimating in-hospital and 6-month mortality risk in patients presenting with acute coronary syndrome. The score sums points across eight factors, age, heart rate, systolic blood pressure, serum creatinine, Killip class, cardiac arrest at admission, ST-segment deviation, and elevated cardiac enzymes.

Enter the applicable clinical values below to see your total GRACE score and both in-hospital and 6-month mortality risk categories. For a related tool used later in the same care pathway, see the DAPT Calculator; for a non-acute exercise-based risk tool, see the Duke Treadmill Score Calculator.

Why Use a GRACE Calculator?

Manually summing eight differently-scaled point tables, including a systolic blood pressure table that runs in reverse, under time pressure in an acute care setting is genuinely error-prone. This calculator performs the full point summation instantly and shows exactly which factors are driving the total score.

It's useful for reviewing a patient's or your own GRACE score components ahead of a cardiology discussion, or for students and clinicians checking a worked GRACE score example against the published point tables.

Who Should Use This Calculator?

Clinicians, nursing staff, and students learning acute coronary syndrome risk stratification can use this tool to check worked GRACE score examples against the published point-band tables. Patients or family members reviewing a recent hospitalization for acute coronary syndrome may find this a useful educational reference for understanding the terminology used in their discharge summary.

This calculator is strictly for informational and educational purposes and is not a substitute for a cardiologist's clinical judgment. Decisions about invasive strategy timing, cardiac catheterization, or overall acute coronary syndrome management must always be made by a qualified cardiologist reviewing the complete clinical presentation, never from this tool alone.

What Insights Does the GRACE Calculator Give You?

GRACE Score is the primary result, your total points summed across all eight scored factors.

In-Hospital Mortality Risk and 6-Month Mortality Risk each translate that same total score into a plain-language low, intermediate, or high risk category, using the published point-to-outcome bands for each respective timeframe.

How to use this GRACE Score calculator

  1. Enter Age in years.
  2. Enter Heart Rate in beats per minute.
  3. Enter Systolic Blood Pressure in mmHg.
  4. Enter Serum Creatinine in mg/dL.
  5. Select the applicable Killip Class, I through IV.
  6. Select Yes or No for Cardiac Arrest at Admission.
  7. Select Yes or No for ST-Segment Deviation.
  8. Select Yes or No for Elevated Cardiac Enzymes.
  9. Review your GRACE Score and both mortality risk categories, and discuss the result with a qualified cardiologist.
Show formula & methodology ↓Show less ↑

Formula & Methodology

The GRACE 1.0 score sums points from independently scored bands for each factor: age (0-100 points across bands from under 30 to 90+), heart rate (0-46 points), systolic blood pressure (0-58 points, scored in reverse so lower pressure adds more), serum creatinine (1-28 points), Killip class (0 points for Class I up to 59 for Class IV), cardiac arrest at admission (+39 points), ST-segment deviation (+28 points), and elevated cardiac enzymes (+14 points), per the original GRACE registry point tables (Granger CB, et al. Arch Intern Med. 2003;163(19):2345-2353; Fox KA, et al. BMJ. 2006;333(7578):1091).

Worked example: A 68-year-old patient with a heart rate of 95 bpm, systolic BP of 110 mmHg, creatinine of 1.3 mg/dL, Killip Class II, no cardiac arrest, positive ST-segment deviation, and elevated enzymes scores approximately 58 (age) + 15 (heart rate) + 43 (SBP) + 10 (creatinine) + 20 (Killip) + 0 (arrest) + 28 (ST) + 14 (enzymes) = 188 points, placing them in the high-risk category for both in-hospital and 6-month mortality, per the published GRACE risk bands.

Frequently Asked Questions

What does the GRACE score predict?
The GRACE (Global Registry of Acute Coronary Events) score predicts in-hospital and 6-month mortality risk for patients presenting with acute coronary syndrome, combining age, vital signs, kidney function, and clinical findings into a single point total. It's one of the most widely used and validated risk scores in acute cardiac care.
What factors go into the GRACE score?
The score sums points for age, heart rate, systolic blood pressure, serum creatinine, Killip class (a measure of heart failure severity), cardiac arrest at admission, ST-segment deviation on ECG, and elevated cardiac biomarkers such as troponin. Each factor is scored in bands, with more extreme values contributing more points.
Why does lower blood pressure add more points?
Unlike most of the other factors, systolic blood pressure is scored in reverse, lower readings add more points because hypotension in acute coronary syndrome reflects more severe hemodynamic compromise and worse prognosis. A systolic BP under 80 mmHg adds the maximum 58 points, while 200 mmHg or higher adds 0.
What is Killip class and why does it matter so much?
Killip class describes the severity of heart failure symptoms at presentation, ranging from Class I (no signs of heart failure) to Class IV (cardiogenic shock). It carries some of the largest point values in the GRACE score because it strongly predicts short-term mortality in acute coronary syndrome.
What do the risk categories mean?
For in-hospital mortality, a score under 109 is low risk (under 1% mortality), 109-140 is intermediate (1-3%), and above 140 is high risk (over 3%). For 6-month mortality, the thresholds are lower: under 89 is low risk, 89-118 is intermediate, and above 118 is high risk.
Why are there two separate risk categories shown?
The same total GRACE score maps to different point cutoffs depending on whether you're estimating in-hospital mortality (the immediate hospitalization period) or 6-month mortality (a longer follow-up window), because the relationship between score and outcome differs across these two timeframes. Reviewing both gives a fuller picture of near-term and medium-term risk.
How is the GRACE score used clinically?
Higher GRACE scores generally support a more aggressive treatment strategy, including earlier invasive coronary angiography, in patients with acute coronary syndrome. It's frequently used alongside other clinical judgment to help time and prioritize catheterization lab referrals.
Can the GRACE score be calculated without a lab value like creatinine?
Creatinine is one of the eight required inputs and reflects kidney function, which is independently associated with mortality risk in acute coronary syndrome. An accurate score requires a recent serum creatinine measurement, typically drawn at hospital admission.
Can this calculator tell me if I need a cardiac catheterization?
No, this calculator is for informational and educational purposes only and simply reproduces the published GRACE scoring system. Decisions about invasive strategy timing, catheterization, or overall treatment in acute coronary syndrome must always be made by a qualified cardiologist reviewing your complete clinical presentation, never from this tool alone.
Is there a difference between GRACE 1.0 and GRACE 2.0?
GRACE 2.0 is a refined web/app-based nomogram version that produces continuous mortality percentages directly, while GRACE 1.0, implemented here, uses the original published integer point-band tables that sum to a score mapped to risk categories. Both are based on the same underlying GRACE registry data and produce broadly consistent risk stratification.
How does this relate to the DAPT Calculator in this same tool set?
The [DAPT Calculator](/dapt-calculator/) is typically used around 12 months after coronary stenting to decide on antiplatelet therapy duration, while the GRACE score is calculated at the time of the acute coronary syndrome event itself to guide immediate treatment intensity. They apply to different stages of the same patient's cardiac care journey.
Does the GRACE score account for exercise stress test results?
No, the GRACE score is calculated at the time of acute presentation using vital signs, labs, and clinical findings, not exercise testing. For risk stratification based on a stress test, see the [Duke Treadmill Score Calculator](/duke-treadmill-score-calculator/), which is used in a different, typically non-acute clinical context.
Also known as
GRACE risk score calculatoracute coronary syndrome risk calculatorGRACE ACS mortality calculatorGRACE 2.0 score calculatorNSTEMI risk score calculator