GRACE ACS Risk and Mortality Calculator - MDCalc

The GRACE Score involves 8 variables from history, exam, EKG and laboratory testing. · This score has been validated in >20,000 patients in multiple databases ... Thisisanunprecedentedtime.Itisthededicationofhealthcareworkersthatwillleadusthroughthiscrisis.Thankyouforeverythingyoudo.COVID-19ResourceCenterCalcFunctionCalcsthathelppredictprobabilityofadiseaseDiagnosisSubcategoryof'Diagnosis'designedtobeverysensitiveRuleOutDiseaseisdiagnosed:prognosticatetoguidetreatmentPrognosisNumericalinputsandoutputsFormulaMedtreatmentandmoreTreatmentSuggestedprotocolsAlgorithmDiseaseSelect...SpecialtySelect...ChiefComplaintSelect...OrganSystemSelect...PatentPendingLogInEmailAddressPasswordShowForgotyourpassword?LogInOrcreateanewaccount(it'sfree)ForgotPassword?EmailAddressEnteryouremailaddressandwe'llsendyoualinktoresetyourpassword.GetNewPasswordSignInRequiredTosavefavorites,youmustlogin.Creatinganaccountisfree,easy,andtakesabout60seconds.LogInCreateAccountAlreadyhaveanMDCalcaccount?LogintolinkyourfavoritesandrecentlyusedcalcsEmailAddressPasswordShowForgotyourpassword?LogInOrcontinuetoNuanceAttentionCOACHSTUDYparticipants:Theprincipalinvestigatorsofthestudyrequestthatyouusetheofficialversionofthemodifiedscorehere.GRACEACSRiskandMortalityCalculatorEstimatesadmission-6monthmortalityforpatientswithacutecoronarysyndrome.WhentoUsePearls/PitfallsWhyUsePatientswithknownSTEMIorunstableangina/NSTEMI,todeterminemortalityrisk.TheGRACEScoreisaprospectivelystudiedscoringsystemtoriskstratifiypatientswithdiagnosedACStoestimatetheirin-hospitaland6-monthto3-yearmortality.LiketheTIMIScore,itwasnotdesignedtoassesswhichpatients’anginalsymptomsareduetoACS.Note:TheGRACEScorewasrecentlyimproved(GRACE2.0);MDCalcusestheGRACE2.0scoringsystem,butwewilldiscusstheGRACEmodelbelow.TheGRACEScoreinvolves8variablesfromhistory,exam,EKGandlaboratorytesting.(GRACE2.0allowsforsubstitutionsofKillipClassfordiureticusageandforserumcreatininewithhistoryofrenaldysfunction).Thisscorehasbeenvalidatedin>20,000patientsinmultipledatabasesandisextremelywellstudiedandsupported.TheNICEguidelinesrecommendtheGRACEScoreforriskstratificationofpatientswithACS. Manyguidelinesrecommendmoreaggressivemedicalmanagementforpatientswithahighmortality(orevenearlyinvasivemanagementforthesepatients).Knowinga patient’sriskearlymayhelpwithmanagementandprognostication/goalsofcarediscussionswithpatientandfamily. Apatientwithsomenonspecificfeaturesoftheirworkup(history,EKG,troponin)canbemoreobjectivelyriskstratifiedfortheirchestpain,quantifytheirrisk,andpotentiallyleadtoshorterhospitalstays,fewerinappropriateinterventions,andmoreappropriateinterventions. AgeyearsHeartrate/pulsebeats/minSystolicBPmmHgCreatininemg/dLCardiacarrestatadmissionNoYesSTsegmentdeviationonEKG?NoYesAbnormalcardiacenzymesNoYesKillipclass(signs/symptoms)NoCHFRalesand/orJVDPulmonaryedemaCardiogenicshockResult:Pleasefilloutrequiredfields.NextStepsEvidenceCreatorInsightsDr.JoelGoreFromtheCreatorWhat'sthedifferencebetweentheGRACEandGRACE2.0scores?GRACE2.0isanimprovedandrefinedlistofoutcomesfromGRACE;insteadofusingscorerangestocalculateoutcomeslikein-hospitalmortality,wecanactuallycalculateamortalityforeveryscore.PeopleshoulduseGRACE2.0.IsthereadifferencebetweenGRACE2.0andMini-GRACE?No–they'recompletelysubstitutable.WejustdevelopedtheMini-GRACEincaseacliniciandidnotknowapatient'sKillipclassordidnothavetheircreatinineavailable(normallytheseareavailable).Whatoutcomeareyouusingasacardiologist?In-hospital?1-year?3-year?Weusethein-hospitalmortalityoutcomewiththeGRACEscore.IthelpsusdeterminedispositioninourSTEMIpatients;thosewithascoreof130orhighergototheICUaftercatheterization,andthosewithlowerscorescangotoourstepdownunit.Wehaven'thadanybadoutcomesandwe'vealsosavedanumberofICUbedsthiswayforotherpatientsthatneedICU-levelcare.We'llalsooccasionallyusetheGRACEscoreonourhighriskNSTEMIpatientstoconsiderdoingearlyinvasivemanagementasopposedtodelayedinterventioninourNSTEMIpatients.AbouttheCreatorJoelGore,MD,isacardiologistattheUMassMemorialMedicalCenter,whereheisalsotheDirectoroftheAnticoagulationClinic.HeisaprofessorofCardiovascularmedicineattheUniversityofMassachusettsMedicalSchoolandspecializesincardiacprevention.Dr.GoreearnedhismedicaldegreefromtheUniversityofCalgary,andcompletedresidencyandfellowshipatUMassMemorialCenter.HeisalsoboardcertifiedinAddictionPsychiatryandInternalMedicine.ToviewDr.JoelGore'spublications,visitPubMedAreyouDr.JoelGore?Sendusamessagetoreviewyourphotoandbio,andfindouthowtosubmitCreatorInsights!MDCalclovescalculatorcreators–researcherswho,throughintelligentandoftencomplexmethods,discovertoolsthatdescribescientificfactsthatcanthenbeappliedinpractice.Thesearerealscientificdiscoveriesaboutthenatureofthehumanbody,whichcanbeinvaluabletophysicianstakingcareofpatients.Dr.KeithA.A.FoxFromtheCreatorWhydidyoudeveloptheGRACEACSRiskScore?Wasthereaclinicalexperiencethatinspiredyoutocreatethistoolforclinicians?WedevelopedtheGRACEACSriskscorebecausewesawtheneedforbetterriskstratificationtoguidetreatmentofACSandtohelpaddressthe“Treatment-Risk”paradox.Whatpearls,pitfallsand/ortipsdoyouhaveforusersoftheGRACEACSRiskScore?Aretherecasesinwhichithasbeenapplied,interpreted,orusedinappropriately?Itisimportanttoconsidernotonlytotalrisk,butalsoriskthatcanbemodified(MIriskhelpswiththis).WhatrecommendationsdoyouhaveforhealthcareprovidersoncetheyhaveappliedtheGRACEACSRiskScore?Arethereanyadjustmentsorupdatesyouwouldmaketothescoregivenrecentchangesinmedicine?TheGRACE2.0(whichMDCalcuses)hasbeenshowntobemoreaccuratethantheoriginalscore.Othercomments?Anynewresearchorpapersonthistopicinthepipeline?Yes!WearecurrentlyworkingondevelopingmodelstoidentifymodifiableriskandlongtermriskinACSpatients.AbouttheCreatorKeithA.A.Fox,MBBS,FRCP,isprofessorofcardiologyattheUniversityofEdinburgh.Hewasafoundingfellow/BoardmemberoftheEuropeanSocietyofCardiologyandawardedtheSilverMedaloftheESCin2010forhiscontributionstocardiology.ProfessorFox'smajorresearchinterestsareinthemechanismsandmanifestationsofacutecoronaryarterialdiseaseandhisworkextendsfromunderlyingbiologicalmechanismstoinvivostudyandclinicaltrials.ToviewDr.KeithA.A.Fox'spublications,visitPubMedAreyouDr.KeithA.A.Fox?Sendusamessagetoreviewyourphotoandbio,andfindouthowtosubmitCreatorInsights!MDCalclovescalculatorcreators–researcherswho,throughintelligentandoftencomplexmethods,discovertoolsthatdescribescientificfactsthatcanthenbeappliedinpractice.Thesearerealscientificdiscoveriesaboutthenatureofthehumanbody,whichcanbeinvaluabletophysicianstakingcareofpatients.ContentContributorsGrahamWalker,MDRelatedCalcsFraminghamRiskScore(HardCoronaryHeartDisease)TIMIRiskIndexTIMIScoreforUA/NSTEMIHavefeedbackaboutthiscalculator?AbouttheCreatorDr.JoelGoreAreyouDr.JoelGore?Dr.KeithA.A.FoxAreyouDr.KeithA.A.Fox?AlsofromMDCalc...RelatedCalcsFraminghamRiskScore(HardCoronaryHeartDisease)TIMIRiskIndexTIMIScoreforUA/NSTEMIYoumightbeinterestedin...PartnerContentCalculatedDecisions:GRACEACSScoreEmergencyMedicinePracticeContentContributorsGrahamWalker,MD