Cardiologie
Global Registry of Acute Coronary Events Score
Mortaliteitsrisico in het ziekenhuis en na 6 maanden bij ACS.
Inhoud in het Engels
GRACE-score-calculator
Uitkomst
105punten
Laag risico — mortaliteit na 6 maanden < 3%
Hoe je hem gebruikt
- 1
Noteer de vitale parameters bij opname. Eerste hartfrequentie en systolische bloeddruk bij presentatie.
- 2
Neem bloed af bij opname. Creatinine; noteer of troponine/CK-MB verhoogd is.
- 3
Beoordeel ECG en Killip-klasse. Nieuwe ST-deviatie scoort 28 punten; Killip ≥II voegt 20 toe.
Wanneer je hem gebruikt
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.
- Risicostratificatie bij NSTEMI/instabiele angina pectoris
- Hoge GRACE (>140) heeft baat bij een vroeg invasief beleid binnen 24 uur.
- STEMI na PCI
- Voorspelt de mortaliteit na 6 maanden; richtinggevend voor de intensiteit van hartrevalidatie.
- Geen op zichzelf staand triage-instrument
- Gebruik samen met het troponinebeloop en de klinische context.
Over de 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.
Veelgestelde vragen
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.
