Grace risk score

n 1999, the GRACE registry was established for the first time with the help of 94 hospitals from a total of 14 countries worldwide. It is a continuous registry that provides information on the morbidity and mortality of patients with acute coronary syndrome (Gravert 2021).

The Grace risk score (Global Registry of Acute Coronary Events) enables statements to be made on six-month morbidity and mortality already in the acute phase of a confirmed ACS(acute coronary syndrome) and thus on the earliest possible identification of an optimal therapy option (Gravert 2021).

It is not suitable for diagnostic evaluation (Kasper 2015) such as for patients with unclear cause of chest pain. In these cases, the HEART score should be used for risk stratification (Fleischmann 2023).

The GRACE risk score is preferably used in the clinic because it was created from a large register and not from selected study data and can therefore most closely reflect reality. A computer program for everyday clinical use has been developed that can be downloaded from the Internet or as a mobile app at http://gracescore.org (Gravert 2021).

Parameters of the GRACE score

- age of the patient

- History of congestive heart failure

- Z. n. myocardial infarction

- heart rate at rest

- systolic blood pressure

- ST-segment depression

- serum creatinine measured first

- elevation of cardiac enzymes

- inpatient percutaneous coronary intervention NOT performed so far (Eagle 2004)

- Classification in the Killip- Classification

This is used to assess the graduation of heart failure:

- Killip- Class I: No evidence of heart failure

- Killip Class II: Pulmonary congestion, auscultatory rales in the upper or lower half of the lung.

- Killip- Class III: Manifest pulmonary edema with rales in both the upper and lower half of the lung.

- Killip- Class IV: Occurrence of cardiogenic shock (Gravert 2021)

Evaluation of the Grace score

- 1. prediction of intrahospital death is at a score of:

- < 108 at < 1 %

- 109 - 140 at 1 % - 3

- > 140 at > 3 % (Herold 2022)

- 2. death 6 months after the event is percentage at a point value of:

- 1 - 69 points: < 1 %

- 70 - 90 points: 1 - 2.9 %

- 91 - 110 points: 3 - 3.9 %

- 111 - 130 points: 4 - 5.9 %

- 131 - 150 points: 6 - 11 %

- 151 - 170 points: 12 - 19 %

- 171 - 190 points: 20 - 33 %

- 191 - 210 points: 34 - 54 % (Eagle 2004)

- 3. coronary angiography

From a score of > 140 points, early coronary angiography (within 24 h) is recommended (Hartung 2021).

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