Global Registry of Adverse Cardiac Events (GRACE)

NICE recommends the GRACE Score for risk stratification because it is based on a very large (and growing) cohort of registry patients and gives robust mortality figures. The GRACE (Global Registry of Adverse Cardiac Events) score [4] also uses accessible factors but it is slightly more complicated to use than the TIMI risk score and requires computer software or a nomogram. It estimates 6 month mortality and like TIMI, is best suited to patients with known STEMI or NSTEMI. It is recommended by NICE for risk stratification of ACS [6]. The parameters are entered into the risk tool and the mortality figures are calculated by the nomogram. It is slightly less convenient to use in the ED than the TIMI score because it requires two blood assay results to complete the assessment (creatinine and troponin) and a computer to generate the risk.

Six month mortality and level of risk

Table 1

Treatment strategies (pharmacological and mechanical) are then recommended by NICE based on the level of risk as determined by GRACE (see later in the session).