Grander et al developed a model for the prediction of in-hospital mortality for a patient who presents with an acute coronary syndrome (ACS). This can help identify patients who may benefit from more aggressive management. The authors are from Global Registry of Acute Coronary Events (GRACE) Investigators.
Patient selection: ACS with or without ST-segment elevation
Parameters:
(1) Killip class (on presentation)
(2) systolic blood pressure in mm Hg (on presentation)
(3) heart rate in beats per minute (on presentation)
(4) age in years
(5) serum creatinine in mg/dL (on presentation)
(6) cardiac arrest at admission
(7) ST-segment deviation
(8) serum cardiac enzyme levels (on presentation)
|
Parameter |
Finding |
Points |
|
Killip class |
I |
0 |
|
|
II |
20 |
|
|
III |
39 |
|
|
IV |
59 |
|
systolic blood pressure |
< 80 mm Hg |
58 |
|
|
80 - 99 |
53 |
|
|
100 - 119 |
43 |
|
|
120 - 139 |
34 |
|
|
140 - 159 |
24 |
|
|
160 - 199 |
10 |
|
|
>= 200 |
0 |
|
heart rate |
< 50 beats per minute |
0 |
|
|
50 - 69 |
3 |
|
|
70 - 89 |
9 |
|
|
90 - 109 |
15 |
|
|
110 - 149 |
24 |
|
|
150 - 199 |
38 |
|
|
>= 200 |
46 |
|
age in years |
< 30 years of age |
0 |
|
|
30 - 39 |
8 |
|
|
40 - 49 |
25 |
|
|
50 - 59 |
41 |
|
|
60 - 69 |
58 |
|
|
70 - 79 |
75 |
|
|
80 - 89 |
91 |
|
|
>= 90 |
100 |
|
serum creatinine |
< 0.40 |
1 |
|
|
0.40 - 0.79 |
4 |
|
|
0.80 - 1.19 |
7 |
|
|
1.20 - 1.59 |
10 |
|
|
1.60 - 1.99 |
13 |
|
|
2.00 - 3.99 |
21 |
|
|
>= 4.00 |
28 |
|
cardiac arrest |
no |
0 |
|
|
yes |
39 |
|
ST-segment deviation |
no |
0 |
|
|
yes |
28 |
|
serum cardiac enzymes |
not elevated |
0 |
|
|
elevated |
14 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 1
• maximum score: 372
• The higher the score the greater the probability of in-hospital mortality.
|
Total Score |
Probability of In-Hospital Mortality |
|
< 60 |
< 0.2% |
|
60 - 250 |
(0.00001289 * ((score)^3)) - (0.003583 * ((score)^2)) + (0.3420 * (score)) - 10.40 |
|
> 250 |
>52% |
Specialty: Cardiology
ICD-10: ,
