Cardiologie
Global Registry of Acute Coronary Events Score
Risque de mortalité hospitalière et à 6 mois dans le SCA.
Contenu en anglais
Calculateur Score GRACE
Résultat
105points
Risque faible — mortalité à 6 mois < 3%
Comment l’utiliser
- 1
Relever les constantes à l’admission. Première FC et première PAS à l’arrivée.
- 2
Prélever le bilan d’admission. Créatinine ; noter si troponine/CK-MB élevées.
- 3
Évaluer l’ECG et la classe Killip. Une nouvelle déviation du ST vaut 28 points ; Killip ≥II ajoute 20.
Quand l’utiliser
Apply to all patients presenting with NSTE-ACS (NSTEMI or unstable angina) to guide timing of coronary angiography and determine in-hospital and post-discharge prognosis.
- Stratification du risque NSTEMI/angor instable
- Un GRACE élevé (>140) justifie une stratégie invasive précoce dans les 24 heures.
- STEMI après angioplastie
- Prédit la mortalité à 6 mois ; oriente l’intensité de la réadaptation.
- Pas un outil de tri isolé
- À utiliser avec la cinétique de la troponine et le contexte clinique.
À propos du score
The GRACE (Global Registry of Acute Coronary Events) score is the recommended risk stratification tool for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), including NSTEMI and unstable angina. It was derived from a multinational registry of over 100,000 ACS patients and predicts both in-hospital and 6-month mortality using eight clinical variables. The score directly informs the timing of coronary angiography: very high-risk patients require immediate invasive strategy (<2 hours), while high-risk patients should undergo early invasive strategy within 24 hours. ESC 2023 ACS guidelines designate GRACE as the preferred quantitative risk tool for NSTE-ACS.
Questions fréquentes
What is a high GRACE score?
A GRACE score >140 indicates high in-hospital mortality risk (>3%) and requires an early invasive strategy within 24 hours per ESC 2023 guidelines. Scores >200 in the context of haemodynamic instability constitute a very-high-risk presentation.
What is the difference between GRACE and TIMI score in ACS?
The GRACE score is more accurate and guideline-preferred for NSTE-ACS because it was derived from a larger real-world registry and incorporates continuous variables (age, BP, HR, creatinine). The TIMI score is simpler to calculate at the bedside but has lower discriminatory accuracy. ESC 2023 recommends GRACE for routine clinical use.
