Correct Answer:

140

Educational Objective:

Review the use of GRACE scores to evaluate risk in patients with chest pain.

Key Point:

GRACE scores are useful for decision-making and prognostication. It is important to know that the American Heart Association and American College of Cardiology specifically use 140 as the critical number.

Explanation:

The GRACE 2.0 score is a quick and easy way to help understand how much risk any individual patient may be at for early, adverse coronary events. It is available at several websites, including this one.

Several other coronary risk calculation models are also available. The AHA specifically mentions the GRACE 2.0 scores in its guidelines, with a score > 140 alone in a stable patient without recurrent pain suggesting that early invasive therapy (within 24 hours) is warranted.

In stable patients without ongoing chest pain, a GRACE score <109 suggests that ischemia-guided therapy may be the best approach; whereas Grace scores of between 109 and 140 suggest that delayed invasive therapy (at 25 to 72 hours after event) might be beneficial. The AHA also refers to the TIMI score in the same guidelines; increasingly, clinicians will need to be familiar with at least one of these scoring systems.

References:

Amsterdam EA, Wenger NK, Brindis RG, et al; ACC/AHA Task Force Members; Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation. 2014;130(25):e431-e432]. Circulation. 2014;130(25):2354-2394.

MDCalc. GRACE ACS risk and mortality calculator. Published 2016. Accessed April 3, 2017.