2. Sum Points for All Predictive Factors:
Killip
Class
+ SB +
Heart
Rate
+ Age +
Creatinine
Level
+
Cardiac
Arrest at
Admission
+
ST-
Segment
Deviation
+
Elevated
Cardiac
Enzyme
Levels
=
Total
Points
Diagnosis
4
Figure 2. GRACE Risk Model Nomogram
1. Find Points for Each Predictive Factor:
Killip
Class Points
SBP,
mm Hg Points
Heart
Rate,
beats/
min Points
Age,
years Points
Creatinine
Level,
mg/dL Points
I 0 ≤80 58 ≤50 0 ≤30 0 0-0.39 1
II 20 80-99 53 50-69 3 30-39 8 0.40-0.79 4
III 39 100-119 43 70-89 9 40-49 25 0.80-1.19 7
IV 59 120-139 34 90-109 15 50-59 41 1.20-1.59 10
140-159 24 110-149 24 60-69 58 1.60-1.99 13
160-199 10 150-199 38 70-79 75 2.00-3.99 21
≥200 0 ≥200 46 80-89 91 >4.0 28
≥90 100
3. Look Up Risk Corresponding to Total Points:
Total
Points
≤60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 ≥250
Probability
of In-
Hospital
Death, %
≤0.2 0.3 0.4 0.6 0.8 1.1 1.6 2.1 2.9 3.9 5.4 7.3 9.8 13 18 23 29 36 44 ≥52
For example, a patient has Killip class II, SBP of 100 mm Hg, heart rate of 100 beats/min,
is 65 years of age, has serum creatinine level of 1.0 mg/dL, did not have a cardiac arrest at
admission but did have ST-segment deviation and elevated enzyme levels. His score would
be: 20 + 53 + 15 + 58 + 7 + 0 + 28 + 14 = 196. is person would have about a 16% risk
of having an in-hospital death.
Similarly, a patient with Killip class I, SBP of 80 mm Hg, heart rate of 60 beats/min, is 55
years of age, has serum creatinine level of 0.4, and no risk factors would have the following
score: 0 + 58 + 3 + 41 + 1 = 103, which gives approximately a 0 .9% risk of having an
in-hospital death.
To convert serum creatinine level to micromoles per liter, multiply by 88.4.
Modified with permission from Granger CB, Goldberg RJ, Dabbous O, et al. Predictors
of hospital mortality in the Global Registry of Acute Coronary Events. Arch Intern Med.
2003;163:2345-2353.
Other Risk Factors Points
Cardiac Arrest at Admission 39
ST-Segment Deviation 28
Elevated Cardiac Enzyme Levels 14
