In-hospital mortality risk in acute coronary syndrome from 8 parameters. Used to select timing of invasive strategy.
GRACE 2.0 predicts in-hospital and 6-month mortality in acute coronary syndrome. Updated from the original GRACE (2003) – Fox et al. (BMJ Open, 2014). Eight variables: age, heart rate, systolic BP, creatinine, Killip class, cardiac arrest at admission, ST deviation, troponin elevation. Interpretation (ESC 2023, ACC/AHA 2022). <109 – low risk, 6-month death <4.4%. 109-140 – intermediate 4.4-11.4%. >140 – high >11.4%, early invasive strategy indicated within 24 hours (coronary angiography with possible revascularization). Clinical use. Decision-making in NSTEMI and unstable angina: time to coronary angiography (immediate in cardiogenic shock or hemodynamic instability, within 2 hours in high-risk ACS, within 24 hours when GRACE >140, within 72 hours when GRACE 109-140 with persistent ischemia). Low risk – noninvasive ischemia evaluation (stress echo, perfusion imaging). STEMI – immediate reperfusion regardless of GRACE. Advantages over TIMI. GRACE more accurately predicts mortality and applies across the ACS spectrum (NSTEMI, STEMI, unstable angina). TIMI is better for recurrent ischemic events and antiplatelet decisions. Limitations. Does not capture cardiogenic shock, atrial fibrillation, ejection fraction – with LVEF <40% or Killip III-IV the prognosis is worse than calculated. Not validated under age 30 with spontaneous coronary artery dissection, vasculitis, cardiac sarcoidosis.
Formula version: grace2-fox-2014-esc-2023-v1
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