GRACE ACS Risk Score
Predicts in-hospital and 6-month mortality in acute coronary syndrome patients using the GRACE 2.0 simplified model
- Highest activation tier
- Recommended
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Care settings
- Emergency department, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The GRACE ACS Risk Score can activate when the transcript or pasted chart context documents any of these:
- NSTEMI
- STEMI
- Unstable angina
- Acute coronary syndrome
- ACS risk stratification
- Inpatient ACS management
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I21.
Note-type scope: it activates on notes whose subject resolves to cardiology, emergency medicine, critical care, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
8 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Patient age in years | age | ||
| Heart rate at presentation (bpm) | vital | bpm | |
| Systolic blood pressure (mmHg) | vital | mmHg | |
| Serum creatinine (mg/dL) | lab | mg/dL | |
| Killip class (1-4) | exam | ||
| Cardiac arrest at admission | history | ||
| ST-segment deviation on ECG | exam | ||
| Elevated cardiac enzymes/biomarkers | lab |
Scoring
GRACE 2.0 simplified model: Age + heart rate + systolic BP + serum creatinine + Killip class + cardiac arrest at admission + ST deviation + elevated cardiac enzymes. Score range 1-372.
Weighted points from age Patient age in years, HR Heart rate at presentation (bpm), SBP Systolic blood pressure (mmHg), Cr Serum creatinine (mg/dL), Killip Killip class (1-4), arrest Cardiac arrest at admission, ST dev ST-segment deviation on ECG, enzymes Elevated cardiac enzymes/biomarkers (GRACE 2.0 lookup tables)
Interpretation
In-hospital mortality: Low risk ≤108 (<1%), Intermediate 109-140 (1-3%), High >140 (>3%). Post-discharge 6-month: Low ≤88 (<3%), Intermediate 89-118 (3-8%), High >118 (>8%).
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)Fox et al. (GRACE) BMJ 2006 · 2006 · GRACE Study Group · Level I · link last verified 2026-03-23
How Scribeable handles it in the note
When an encounter activates the GRACE ACS Risk Score (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated GRACE ACS Risk Score value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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