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CardiologyGRACE 1.0

Classic GRACE 1.0 Score Calculator

Calculate the classic 2003 GRACE bedside point score for in-hospital mortality in adult acute coronary syndrome.

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Model identity: classic GRACE 1.0 bedside point score for the in-hospital mortality endpoint described by Granger and colleagues in 2003. This page does not implement the separate six-month, GRACE 2.0, or GRACE 3.0 models and does not convert the total into an individual mortality probability.

Use the index presentation for an adult with acute coronary syndrome. Do not repurpose this model for pediatric care, non-ACS presentations, or post-discharge prognosis.

years

Enter completed adult years. The age bands are part of the historical point table; input limits are calculator safeguards, not a healthy or expected age range.

beats/min

Use the heart rate measured during the index ACS presentation. Enter a positive ordinary decimal.

mmHg

Use systolic blood pressure from the same index presentation, in mmHg. Enter a positive ordinary decimal.

Select the unit printed with the initial serum creatinine result. Changing the unit clears the creatinine value and any previous result so a number is never silently reinterpreted.

Use the initial result from the index presentation. Positive ordinary decimals only; technical display limits are not laboratory reference intervals.

Use the bedside Killip class documented at the index presentation. The categories reflect clinical heart-failure or shock findings, not an echocardiographic grade.

Answer Yes only for cardiac arrest during the acute presentation, not a remote history.

Use the reporting laboratory’s threshold for the initial cardiac biomarker result; the page does not interpret assay-specific concentrations.

Use qualifying ST-segment elevation or depression on the presenting ECG under the original GRACE definition.

About

This page reproduces the classic 2003 GRACE 1.0 bedside point score for the in-hospital death endpoint during an adult acute coronary syndrome (ACS) index presentation. The GRACE registry was a multinational, observational ACS registry, not a treatment-effect trial. ACS means an acute reduction in coronary blood flow and includes unstable angina, NSTEMI, and STEMI, but an applicable clinical pathway must assess that diagnosis before this historical score is used. [1, 2]

Granger and colleagues derived the classic model in 11,389 registry patients, including 509 in-hospital deaths, from the 1999–2001 treatment era. Its eight presentation predictors are age, heart rate, systolic blood pressure, initial serum creatinine, Killip class, cardiac arrest at admission or during presentation, elevated initial cardiac markers, and ST-segment deviation. The form reports only the discrete point total; it does not read an ECG, interpret a biomarker, infer Killip class, or calculate a probability. [2, 14]

The GRACE family also contains different post-discharge, GRACE 2.0, GRACE 3.0, and later extension models. Their populations, endpoints, functions, variables, and calibration cannot be reconstructed from this classic point table. This page therefore does not provide a discharge estimate, one-year risk, individualized treatment effect, diagnosis, or treatment instruction. [3, 4, 5, 6, 7]

Formula

Classic GRACE 1.0 in-hospital point score = age + heart rate + systolic blood pressure + initial creatinine + Killip class + cardiac arrest + elevated initial cardiac markers + ST-segment deviation points. [2]
Cardiac arrest at admission/during presentation = 39 points; elevated initial cardiac markers = 14 points; ST-segment deviation = 28 points. Killip I/II/III/IV = 0/20/39/59 points. [2, 14]
The published discrete point range reproduced here is 1–372. A positive creatinine below 0.4 mg/dL contributes the minimum 1 point. The original nomogram can relate points to cohort estimates, but this page deliberately does not rebuild or report a mortality probability. [2]
Creatinine normalization: mg/dL = µmol/L ÷ 88.4. Points use the exact normalized value at the published boundaries; formatting occurs only after calculation. This conversion is a unit operation, not a kidney function estimate. [2]

Interpretation

GRACE versions and endpoints are not interchangeable
ModelPopulationWhat it predicts
Classic GRACE 1.0 (this page)Broad ACS spectrum in the original registry eraIn-hospital death; categorical bedside point table
GRACE post-discharge modelsPatients surviving an ACS hospitalizationSix-month post-discharge death; different model and variables
GRACE 2.0 (2014)ST-elevation and non-ST-elevation ACSShort- and longer-term probability estimates using nonlinear functions and optional missing-variable substitutions
GRACE 3.0 (2022)Contemporary NSTE-ACS cohortsSex-specific machine-learning estimates of in-hospital mortality

What the inputs mean

Killip class is a bedside clinical classification of heart failure or shock at presentation. ST-segment deviation means qualifying elevation or depression on the presenting ECG in the original GRACE definition. Cardiac markers are initial myocardial-injury biomarkers such as troponin, interpreted against the reporting laboratory’s assay threshold. “Cardiac arrest” refers to arrest during the acute presentation, not any remote history.

Current guideline context

The 2025 ACC/AHA acute-coronary-syndrome guideline and the 2023 ESC guideline use structured risk assessment within a broader clinical pathway. In confirmed NSTE-ACS, the 2023 ESC guideline retains GRACE >140 as one high-risk feature in the context where an early invasive strategy within 24 hours should be considered. This source-specific static context is not a diagnosis, automatic instruction, dynamic comparison, or treatment selector on this page. [8, 13]

Important limitations

The classic point table was derived from patients enrolled in 1999–2001 and cannot provide a universally calibrated contemporary probability for an individual. Performance, calibration, biomarkers, treatment era, sex distribution, ACS phenotype, renal function, frailty, comorbidity, and local care pathways matter. A low point total does not rule out ACS, myocardial infarction, deterioration, or another emergency; a high total does not confirm any diagnosis or select a treatment.

The mean arterial pressure calculator estimates a different hemodynamic quantity, while the shock index calculator reports heart rate divided by systolic pressure. Neither is a substitute for the eight-variable GRACE model.

Classic GRACE 1.0 point table

These static tables reproduce the categorical bedside bands used by the classic model. Boundaries are model mechanics, not healthy ranges, treatment thresholds, or dynamic classifications. [2]

Age (completed years)
Published bandPoints
<300
30–398
40–4925
50–5941
60–6958
70–7975
80–8991
≥90100
Heart rate (beats/min)
Published bandPoints
<500
50–693
70–899
90–10915
110–14924
150–19938
≥20046
Systolic blood pressure (mmHg)
Published bandPoints
<8058
80–9953
100–11943
120–13934
140–15924
160–19910
≥2000
Initial serum creatinine
Published bandPoints
<0.4 mg/dL (<35.36 µmol/L)1
0.4–<0.8 mg/dL (35.36–<70.72 µmol/L)4
0.8–<1.2 mg/dL (70.72–<106.08 µmol/L)7
1.2–<1.6 mg/dL (106.08–<141.44 µmol/L)10
1.6–<2.0 mg/dL (141.44–<176.8 µmol/L)13
2.0–<4.0 mg/dL (176.8–<353.6 µmol/L)21
≥4.0 mg/dL (≥353.6 µmol/L)28
Killip class documented at presentation
Published bandPoints
I — no clinical signs of heart failure0
II — rales/crackles, elevated jugular venous pressure, or S320
III — acute pulmonary edema39
IV — cardiogenic shock59
Binary presentation components
Published bandPoints
Cardiac arrest at admission/during presentation39
Elevated initial cardiac markers14
ST-segment deviation28

Creatinine boundaries use the unrounded normalized value: 35.36, 70.72, 106.08, 141.44, 176.8, and 353.6 µmol/L correspond exactly to 0.4, 0.8, 1.2, 1.6, 2.0, and 4.0 mg/dL at 88.4 µmol/L per mg/dL. The runtime does not highlight a selected row.

What this calculator computes

  1. Reads the eight presentation variables supplied for the index ACS admission.
  2. Maps each value to its published discrete band or binary point.
  3. Adds those points without estimating a probability or adding an unrequested variable.
  4. Shows the classic total and a submitted-component audit.

It does not read an ECG, interpret a biomarker, infer Killip class, or retrieve serial values, and it does not calculate an ACS diagnosis, stage, cause, prognosis, test, or treatment. [1, 2]

What the eight inputs mean

InputRequired meaningWhat this page does not infer
AgeCompleted years at the index presentation.No age-based diagnosis or adjustment.
Heart rateMeasurement from the same index ACS presentation.No rhythm or ECG interpretation.
Systolic blood pressureInitial index-presentation SBP in mmHg.No blood-pressure diagnosis or shock treatment.
Initial creatinineThe initial laboratory result in its reported unit.No eGFR, clearance, CKD stage, or dose.
Killip classA clinician-documented bedside heart-failure/shock class.No automatic inference from BP, symptoms, or one field.
Cardiac arrestArrest at admission or during the acute presentation.No post-arrest treatment recommendation.
Initial cardiac markersWhether the initial marker is elevated against the reporting laboratory threshold.No assay interpretation or 0/1-hour or 0/2-hour algorithm.
ST-segment deviationA qualifying elevation or depression identified on the presenting ECG.No ECG reading or STEMI/NSTEMI diagnosis.

Combine measurements only when they describe the same clinical event and a reasonably consistent time point. Do not mix admissions, hospital days, post-treatment values, or remote self-measurements. Killip class remains a clinical assessment, and cardiac markers and ST deviation require the relevant clinical records. [1, 2, 14]

Why there is no mortality probability or nomogram here

The 2003 paper supplied a nomogram relating a point total to cohort estimates. This page deliberately does not rebuild that graphic or convert a score into a patient-level probability: calibration depends on registry era, treatment, biomarker practice, renal function, frailty, comorbidity, and case mix. A low total does not rule out ACS or deterioration, and a high total does not confirm a diagnosis or determine management. [1, 2]

Historical studies and model-family development

The registry design established a multinational observational cohort. Granger 2003 derived this classic in-hospital endpoint. Eagle 2004 and Fox 2006 address six-month post-discharge outcomes, and Bradshaw externally validated a six-month model in an independent dataset. Fox 2014 uses continuous nonlinear GRACE 2.0 functions; Wenzl 2022 develops sex-specific GRACE 3.0 models; and Wenzl 2025 extends the family in 609,063 NSTE-ACS patients across ten countries with one-year and individualized treatment-effect models. These models are not conversions of the discrete score on this page. [1, 3, 4, 5, 6, 7, 15]

Version and endpoint boundaries

VersionPopulation/time originEndpoint or use
Classic GRACE 1.0 (this page)Adult ACS index presentationIn-hospital death; categorical points
Six-month/post-discharge modelsSurvivors after an ACS admissionSix-month post-discharge death; different model
GRACE 2.0 (2014)ACS cohortsNonlinear short- and longer-term probability models
GRACE 3.0 (2022)Contemporary NSTE-ACS cohortsSex-specific redevelopment, not this point table
2025 GRACE extensionTen-country NSTE-ACS development/validationOne-year and individualized treatment-effect modelling

Do not substitute a six-month, one-year, GRACE 2.0, GRACE 3.0, or treatment-effect model for the classic table, and do not infer one model’s endpoint from another. [3, 4, 5, 6, 7]

Killip class and presentation variables

Killip class is a clinician-documented bedside description of heart failure or shock at presentation: class I has no clinical signs, class II may include rales, elevated jugular venous pressure, or S3, class III is acute pulmonary edema, and class IV is cardiogenic shock. This form does not infer a class from blood pressure, symptoms, or another field. Cardiac arrest, cardiac-marker elevation, and ST-segment deviation likewise require the relevant contemporaneous records. [2, 14]

Creatinine normalization and published boundaries

Initial creatinine is normalized to mg/dL by dividing a µmol/L result by 88.4. The exact normalized value is assigned to one of the published bands: <0.4 = 1, 0.4–<0.8 = 4, 0.8–<1.2 = 7, 1.2–<1.6 = 10, 1.6–<2.0 = 13, 2.0–<4.0 = 21, and ≥4.0 = 28 points. This is a score unit operation, not an eGFR, clearance, CKD stage, or treatment threshold. [2]

Why the original nomogram is not rebuilt

A point-to-probability nomogram belongs to the calibration and endpoint of its source cohort. Present-day users may enter values from a different population, assay era, treatment pathway, or time origin. The page therefore preserves the transparent point arithmetic and avoids implying that a copied probability is an individualized prognosis. [1, 2]

Current guideline context

The 2025 ACC/AHA acute-coronary-syndrome guideline and its checked publication corrections, together with the 2023 ESC guideline, place structured risk assessment inside a broader clinical pathway. In confirmed NSTE-ACS, ESC 2023 retains GRACE >140 as one high-risk feature in the context where an early invasive strategy within 24 hours should be considered. That is source-specific static context, not a diagnosis, automatic instruction, dynamic comparison, or treatment selector on this page. [8, 9, 10, 11, 12, 13]

Special situations and limits

The classic table is not a general-purpose tool for STEMI reperfusion, cardiogenic shock, cardiac-arrest aftercare, severe renal failure or dialysis, pregnancy, children, non-ACS chest pain, remote self-testing, post-transfer values, recurrent ACS, or post-discharge follow-up. These contexts can require different data, time origins, urgency, and pathways. The page does not choose angiography, PCI, CABG, transfer, admission, monitoring, medication, dose, or any treatment.

Evidence and publication-correction check

The current 2025 U.S. guideline record and its Circulation and parallel JACC correction notices were checked for publication accuracy. Those notices do not alter the frozen eight-variable arithmetic or turn this page into a newer GRACE model. [8, 9, 10, 11, 12]

Comparison with MAP and shock index

Mean arterial pressure uses systolic and diastolic pressure; shock index is heart rate divided by systolic pressure. Both are different hemodynamic quantities and neither substitutes for the eight-variable GRACE point table. This page does not derive either quantity or combine it with the submitted score.

Mean arterial pressure calculator and shock index calculator answer different questions.

Static score limits

The reproduced point total is 1–372. It is not a mortality probability, a healthy range, a risk category, or a trigger for escalation. The page never applies a dynamic >140 comparison and never adds probability, diagnosis, cause, or treatment language to a submitted result. [2, 13]

Worked point-total audit

For example, age 65 (58), heart rate 80 (9), SBP 120 (34), creatinine 1 mg/dL (7), Killip II (20), cardiac arrest yes (39), elevated markers yes (14), and ST deviation yes (28) sum to 209 points. The worked arithmetic demonstrates the frozen point table only; it is not a mortality percentage, diagnosis, or treatment recommendation. [2]

References

  1. GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J. 2001;141(2):190–199. PMID 11174331. DOI 10.1067/mhj.2001.112404.
  2. Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events. Arch Intern Med. 2003;163(19):2345–2353. PMID 14581255. DOI 10.1001/archinte.163.19.2345.
  3. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291(22):2727–2733. PMID 15187054. DOI 10.1001/jama.291.22.2727.
  4. Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333(7578):1091. PMID 17032691. PMCID PMC1661748. DOI 10.1136/bmj.38985.646481.55.
  5. Fox KAA, FitzGerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425. PMID 24561498. PMCID PMC3931985. DOI 10.1136/bmjopen-2013-004425.
  6. Wenzl FA, Kraler S, Ambler G, et al. Sex-specific evaluation and redevelopment of the GRACE score in non-ST-segment elevation acute coronary syndromes in populations from the UK and Switzerland: a multinational analysis with external cohort validation. Lancet. 2022;400(10357):744–756. PMID 36049493. DOI 10.1016/S0140-6736(22)01483-0.
  7. Wenzl FA, Kofoed KF, Simonsson M, et al. Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries. Lancet Digit Health. 2025;7(10):100907. PMID 41107201. DOI 10.1016/j.landig.2025.100907.
  8. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 2025;151(13):e771–e862. PMID 40014670. DOI 10.1161/CIR.0000000000001309.
  9. Rao SV, O’Donoghue ML, Ruel M, et al. Correction to: 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 2025;151(13):e865. PMID 40163565. DOI 10.1161/CIR.0000000000001328.
  10. Rao SV, O’Donoghue ML, Ruel M, et al. Correction to: 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 2025;151(25):e1098. DOI 10.1161/CIR.0000000000001346.
  11. Rao SV, O’Donoghue ML, Ruel M, et al. Correction to: 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 2025;152:e402. PMID 41212941. DOI 10.1161/CIR.0000000000001397.
  12. Correction to: 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2025;85(18):1800. PMID 40335258. DOI 10.1016/j.jacc.2025.03.500.
  13. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826. PMID 37622654. DOI 10.1093/eurheartj/ehad191.
  14. Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients. Am J Cardiol. 1967;20(4):457–464. PMID 6059183. DOI 10.1016/0002-9149(67)90023-9.
  15. Bradshaw PJ, Ko DT, Newman AM, Donovan LR, Tu JV. Validity of the GRACE acute coronary syndrome prediction model for six month post-discharge death in an independent data set. Heart. 2006;92(7):905–909. PMID 16387810. PMCID PMC1860727. DOI 10.1136/hrt.2005.073122.

FAQ

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Disclaimer

Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.