Updated GRACE ACS Risk and Mortality Calculator

The GRACE (and GRACE 2.0) risk score is a well-validated, internationally derived prognostic model for mortality after acute coronary syndrome (ACS). Its primary strengths are large multicenter derivation, consistent discrimination, and the extension in GRACE 2.0 to non-linear modeling and 1–3-year mortality estimates. However, the potential calibration drift over time and across health systems, under- or over-estimation in older/frail patients, and omission of social determinants (socioeconomic deprivation) and frailty which independently affect outcomes are some of the important limitations of the tool. For safe local use, clinicians should consider confirming external validation and calibration in their own setting. They should also be cautious applying the score where data elements are missing or when doing time-sensitive interventions (do not delay reperfusion).