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GRACE in-hospital ACS score

GRACE

Sum the Granger 2003 in-hospital GRACE 1.0 nomogram points from eight admission predictors and return that paper's printed in-hospital mortality readout.

LIVE $0.005 USDC GET /api/calc/grace

Markdown: /docs/grace.md · Canonical: https://magentlab.com/docs/grace

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Sum the Granger 2003 in-hospital GRACE 1.0 nomogram points from eight admission predictors and return that paper's printed in-hospital mortality readout.

When to use

When an agent already has age, heart rate, systolic BP, creatinine, Killip class, cardiac arrest, ST-segment deviation, and initial enzyme flags and needs the Granger 2003 in-hospital point total, not a catheterization order.

When not to use

  • Not a medical device.
  • Not a cath-lab order, reperfusion protocol, or diagnosis of ACS. magent does not interpret the ECG or assign Killip class.
  • Granger 2003 in-hospital GRACE 1.0 integer nomogram only. Not the later continuous GRACE 2.0 model. Not Fox 2006 6-month mortality. Not Eagle 2004 post-discharge.
  • Does not apply later ESC NSTE-ACS ≤108 / 109-140 / >140 cutoffs; those bands are not printed in Granger 2003. in_hospital_mortality_percent is the 2003 nomogram readout (≤60 → 0.2%; labeled 70-240 percents at or below the total; ≥250 → 52%).
  • Cardiac arrest, ST-segment deviation, and elevated enzymes are caller-assigned flags. magent does not read the chart or the laboratory.

Formula

GRACE = age_points(<30:0, 30-39:8, 40-49:25, 50-59:41, 60-69:58, 70-79:75, 80-89:91, >=90:100) + heart_rate_points(<50:0, 50-69:3, 70-89:9, 90-109:15, 110-149:24, 150-199:38, >=200:46) + sbp_points(<80:58, 80-99:53, 100-119:43, 120-139:34, 140-159:24, 160-199:10, >=200:0) + creatinine_mg_dl_points(0-0.39:1, 0.4-0.79:4, 0.8-1.19:7, 1.2-1.59:10, 1.6-1.99:13, 2.0-3.99:21, >=4:28) + killip(1:0, 2:20, 3:39, 4:59) + 39 if cardiac_arrest + 28 if st_deviation + 14 if elevated_enzymes; Granger 2003 in-hospital GRACE 1.0 nomogram; max 372; in_hospital_mortality_percent is that paper's printed score readout (score<=60 → 0.2; then the labeled 70-240 percents at or below the total; score>=250 → 52); not ESC 108/140 cutoffs, not GRACE 2.0, not Fox 2006 6-month

Citation

Title
Predictors of hospital mortality in the global registry of acute coronary events
Authors
Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA; Global Registry of Acute Coronary Events Investigators
Source
Arch Intern Med. 2003;163(19):2345-2353
DOI
10.1001/archinte.163.19.2345

Worked example

Typical NSTE-ACS, Killip I, no arrest, no ST deviation, negative enzymes

Given: age=65cardiac_arrest=falsecreatinine_mg_dl=1.0elevated_enzymes=falseheart_rate_bpm=80killip_class=1sbp_mm_hg=130st_deviation=false

  1. age 65 → 58 (60-69 band)
  2. heart_rate_bpm 80 → 9 (70-89 band)
  3. sbp_mm_hg 130 → 34 (120-139 band)
  4. creatinine_mg_dl 1.0 → 7 (0.8-1.19 band)
  5. killip_class 1 → 0; cardiac_arrest false → 0; st_deviation false → 0; elevated_enzymes false → 0
  6. Score = 108 (max 372); in_hospital_mortality_percent = 0.8 (printed 100 → 0.8%)

Older ACS with Killip III, ST deviation, and elevated enzymes

Given: age=80cardiac_arrest=falsecreatinine_mg_dl=2.2elevated_enzymes=trueheart_rate_bpm=110killip_class=3sbp_mm_hg=90st_deviation=true

  1. age 80 → 91; heart_rate_bpm 110 → 24; sbp_mm_hg 90 → 53; creatinine_mg_dl 2.2 → 21
  2. killip_class 3 → 39; cardiac_arrest false → 0; st_deviation true → 28; elevated_enzymes true → 14
  3. Score = 270 (max 372); in_hospital_mortality_percent = 52.0 (printed ≥250 → ≥52%)

Also searched as

  • GRACE score
  • GRACE in-hospital
  • Granger 2003
  • ACS in-hospital mortality
  • Global Registry of Acute Coronary Events
  • GRACE 1.0
  • in-hospital GRACE
  • Killip GRACE ACS

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/grace?age=65&heart_rate_bpm=80&sbp_mm_hg=130&creatinine_mg_dl=1.0&killip_class=1&cardiac_arrest=false&st_deviation=false&elevated_enzymes=false

Full URL: https://api.magentlab.com/api/calc/grace?age=65&heart_rate_bpm=80&sbp_mm_hg=130&creatinine_mg_dl=1.0&killip_class=1&cardiac_arrest=false&st_deviation=false&elevated_enzymes=false

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge. 

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/grace?age=65&heart_rate_bpm=80&sbp_mm_hg=130&creatinine_mg_dl=1.0&killip_class=1&cardiac_arrest=false&st_deviation=false&elevated_enzymes=false"

Parameters

Name Type Required Description
age integer required Age in years (18-120). Granger 2003 nomogram: <30 scores 0; 30-39 scores 8; 40-49 scores 25; 50-59 scores 41; 60-69 scores 58; 70-79 scores 75; 80-89 scores 91; ≥90 scores 100.
heart_rate_bpm integer required Heart rate in beats/min (20-300). Granger 2003 nomogram: <50 scores 0; 50-69 scores 3; 70-89 scores 9; 90-109 scores 15; 110-149 scores 24; 150-199 scores 38; ≥200 scores 46.
sbp_mm_hg integer required Systolic blood pressure in mm Hg (40-300). Granger 2003 nomogram, inverse: <80 scores 58; 80-99 scores 53; 100-119 scores 43; 120-139 scores 34; 140-159 scores 24; 160-199 scores 10; ≥200 scores 0.
creatinine_mg_dl number optional Initial serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l. If both are sent, creatinine_mg_dl is scored. Granger 2003 nomogram: 0.0-0.39 scores 1; 0.4-0.79 scores 4; 0.8-1.19 scores 7; 1.2-1.59 scores 10; 1.6-1.99 scores 13; 2.0-3.99 scores 21; ≥4.0 scores 28.
creatinine_umol_l number optional Initial serum creatinine in µmol/L (9-1768). Converted as mg/dL = µmol/L / 88.42. Alternate to creatinine_mg_dl. Ignored when creatinine_mg_dl is present.
killip_class integer required Killip class 1-4 as assigned by the caller (1 no heart failure scores 0; 2 rales or elevated venous pressure scores 20; 3 pulmonary edema scores 39; 4 cardiogenic shock scores 59). magent does not examine the patient.
cardiac_arrest boolean required Cardiac arrest at presentation as assigned by the caller (Granger 2003). true scores 39. magent does not read the chart. true or false.
st_deviation boolean required ST-segment deviation on the presenting ECG as assigned by the caller (Granger 2003). true scores 28. magent does not interpret the ECG. true or false.
elevated_enzymes boolean required Elevated initial cardiac enzymes as assigned by the caller (Granger 2003). true scores 14. magent does not read the laboratory. true or false.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/grace Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

  • 1 to 25 items. Each item uses the same keys as the GET query parameters.
  • POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
  • The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
  • HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
  • Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
  • x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "age": "65",
      "cardiac_arrest": "false",
      "creatinine_mg_dl": "1.0",
      "elevated_enzymes": "false",
      "heart_rate_bpm": "80",
      "killip_class": "1",
      "sbp_mm_hg": "130",
      "st_deviation": "false"
    },
    {
      "age": "65",
      "cardiac_arrest": "false",
      "creatinine_mg_dl": "1.0",
      "elevated_enzymes": "false",
      "heart_rate_bpm": "80",
      "killip_class": "1",
      "sbp_mm_hg": "130",
      "st_deviation": "false"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/grace",
  "items": [
    {
      "components": [
        {
          "value": 65,
          "factor": "age",
          "points": 58,
          "present": true
        },
        {
          "value": 80,
          "factor": "heart_rate_bpm",
          "points": 9,
          "present": true
        },
        {
          "value": 130,
          "factor": "sbp_mm_hg",
          "points": 34,
          "present": true
        },
        {
          "value": 1.0,
          "factor": "creatinine_mg_dl",
          "points": 7,
          "present": true
        },
        {
          "value": 1,
          "factor": "killip_class",
          "points": 0,
          "present": false
        },
        {
          "factor": "cardiac_arrest",
          "points": 0,
          "present": false
        },
        {
          "factor": "st_deviation",
          "points": 0,
          "present": false
        },
        {
          "factor": "elevated_enzymes",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA; Global Registry of Acute Coronary Events Investigators",
        "doi": "10.1001/archinte.163.19.2345",
        "id": "granger-2003-grace",
        "pmid": "14581255",
        "source": "Arch Intern Med. 2003;163(19):2345-2353",
        "title": "Predictors of hospital mortality in the global registry of acute coronary events"
      },
      "formula": "grace",
      "formula_expression": "GRACE = age_points(<30:0, 30-39:8, 40-49:25, 50-59:41, 60-69:58, 70-79:75, 80-89:91, >=90:100) + heart_rate_points(<50:0, 50-69:3, 70-89:9, 90-109:15, 110-149:24, 150-199:38, >=200:46) + sbp_points(<80:58, 80-99:53, 100-119:43, 120-139:34, 140-159:24, 160-199:10, >=200:0) + creatinine_mg_dl_points(0-0.39:1, 0.4-0.79:4, 0.8-1.19:7, 1.2-1.59:10, 1.6-1.99:13, 2.0-3.99:21, >=4:28) + killip(1:0, 2:20, 3:39, 4:59) + 39 if cardiac_arrest + 28 if st_deviation + 14 if elevated_enzymes; Granger 2003 in-hospital GRACE 1.0 nomogram; max 372; in_hospital_mortality_percent is that paper's printed score readout (score<=60 → 0.2; then the labeled 70-240 percents at or below the total; score>=250 → 52); not ESC 108/140 cutoffs, not GRACE 2.0, not Fox 2006 6-month",
      "max_score": 372,
      "score": 108,
      "age_years": 65,
      "creatinine_mg_dl": 1.0,
      "heart_rate_bpm": 80,
      "sbp_mm_hg": 130,
      "cardiac_arrest": false,
      "elevated_enzymes": false,
      "in_hospital_mortality_percent": 0.8,
      "killip_class": 1,
      "st_deviation": false
    },
    {
      "components": [
        {
          "value": 65,
          "factor": "age",
          "points": 58,
          "present": true
        },
        {
          "value": 80,
          "factor": "heart_rate_bpm",
          "points": 9,
          "present": true
        },
        {
          "value": 130,
          "factor": "sbp_mm_hg",
          "points": 34,
          "present": true
        },
        {
          "value": 1.0,
          "factor": "creatinine_mg_dl",
          "points": 7,
          "present": true
        },
        {
          "value": 1,
          "factor": "killip_class",
          "points": 0,
          "present": false
        },
        {
          "factor": "cardiac_arrest",
          "points": 0,
          "present": false
        },
        {
          "factor": "st_deviation",
          "points": 0,
          "present": false
        },
        {
          "factor": "elevated_enzymes",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA; Global Registry of Acute Coronary Events Investigators",
        "doi": "10.1001/archinte.163.19.2345",
        "id": "granger-2003-grace",
        "pmid": "14581255",
        "source": "Arch Intern Med. 2003;163(19):2345-2353",
        "title": "Predictors of hospital mortality in the global registry of acute coronary events"
      },
      "formula": "grace",
      "formula_expression": "GRACE = age_points(<30:0, 30-39:8, 40-49:25, 50-59:41, 60-69:58, 70-79:75, 80-89:91, >=90:100) + heart_rate_points(<50:0, 50-69:3, 70-89:9, 90-109:15, 110-149:24, 150-199:38, >=200:46) + sbp_points(<80:58, 80-99:53, 100-119:43, 120-139:34, 140-159:24, 160-199:10, >=200:0) + creatinine_mg_dl_points(0-0.39:1, 0.4-0.79:4, 0.8-1.19:7, 1.2-1.59:10, 1.6-1.99:13, 2.0-3.99:21, >=4:28) + killip(1:0, 2:20, 3:39, 4:59) + 39 if cardiac_arrest + 28 if st_deviation + 14 if elevated_enzymes; Granger 2003 in-hospital GRACE 1.0 nomogram; max 372; in_hospital_mortality_percent is that paper's printed score readout (score<=60 → 0.2; then the labeled 70-240 percents at or below the total; score>=250 → 52); not ESC 108/140 cutoffs, not GRACE 2.0, not Fox 2006 6-month",
      "max_score": 372,
      "score": 108,
      "age_years": 65,
      "creatinine_mg_dl": 1.0,
      "heart_rate_bpm": 80,
      "sbp_mm_hg": 130,
      "cardiac_arrest": false,
      "elevated_enzymes": false,
      "in_hospital_mortality_percent": 0.8,
      "killip_class": 1,
      "st_deviation": false
    }
  ]
}

Response

Field Type Description
formula string grace
formula_expression string Exact expression used
score integer Total Granger 2003 nomogram points 1-372
max_score integer 372 (100+46+58+28+59+39+28+14)
in_hospital_mortality_percent number Granger 2003 printed in-hospital mortality percent for this total (≤60 → 0.2; labeled 70-240 ticks at or below the score; ≥250 → 52). Not an ESC 108/140 band and not an individual prognosis.
age_years integer Age used
heart_rate_bpm integer Heart rate used
sbp_mm_hg integer Systolic BP used
creatinine_mg_dl number Serum creatinine used in mg/dL (after µmol/L conversion when that unit is sent)
killip_class integer Caller-assigned Killip class 1-4 used
cardiac_arrest boolean Caller-assigned cardiac arrest at presentation used
st_deviation boolean Caller-assigned ST-segment deviation used
elevated_enzymes boolean Caller-assigned elevated initial enzymes used
components array Per-predictor nomogram points
citation object Granger 2003 Arch Intern Med citation
disclaimer string Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup. 

{
  "components": [
    {
      "value": 65,
      "factor": "age",
      "points": 58,
      "present": true
    },
    {
      "value": 80,
      "factor": "heart_rate_bpm",
      "points": 9,
      "present": true
    },
    {
      "value": 130,
      "factor": "sbp_mm_hg",
      "points": 34,
      "present": true
    },
    {
      "value": 1.0,
      "factor": "creatinine_mg_dl",
      "points": 7,
      "present": true
    },
    {
      "value": 1,
      "factor": "killip_class",
      "points": 0,
      "present": false
    },
    {
      "factor": "cardiac_arrest",
      "points": 0,
      "present": false
    },
    {
      "factor": "st_deviation",
      "points": 0,
      "present": false
    },
    {
      "factor": "elevated_enzymes",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA; Global Registry of Acute Coronary Events Investigators",
    "doi": "10.1001/archinte.163.19.2345",
    "id": "granger-2003-grace",
    "pmid": "14581255",
    "source": "Arch Intern Med. 2003;163(19):2345-2353",
    "title": "Predictors of hospital mortality in the global registry of acute coronary events"
  },
  "formula": "grace",
  "formula_expression": "GRACE = age_points(<30:0, 30-39:8, 40-49:25, 50-59:41, 60-69:58, 70-79:75, 80-89:91, >=90:100) + heart_rate_points(<50:0, 50-69:3, 70-89:9, 90-109:15, 110-149:24, 150-199:38, >=200:46) + sbp_points(<80:58, 80-99:53, 100-119:43, 120-139:34, 140-159:24, 160-199:10, >=200:0) + creatinine_mg_dl_points(0-0.39:1, 0.4-0.79:4, 0.8-1.19:7, 1.2-1.59:10, 1.6-1.99:13, 2.0-3.99:21, >=4:28) + killip(1:0, 2:20, 3:39, 4:59) + 39 if cardiac_arrest + 28 if st_deviation + 14 if elevated_enzymes; Granger 2003 in-hospital GRACE 1.0 nomogram; max 372; in_hospital_mortality_percent is that paper's printed score readout (score<=60 → 0.2; then the labeled 70-240 percents at or below the total; score>=250 → 52); not ESC 108/140 cutoffs, not GRACE 2.0, not Fox 2006 6-month",
  "max_score": 372,
  "score": 108,
  "age_years": 65,
  "creatinine_mg_dl": 1.0,
  "heart_rate_bpm": 80,
  "sbp_mm_hg": 130,
  "cardiac_arrest": false,
  "elevated_enzymes": false,
  "in_hospital_mortality_percent": 0.8,
  "killip_class": 1,
  "st_deviation": false
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP Code When
400 invalid_grace GRACE in-hospital inputs must match Granger 2003 age, heart rate, SBP, creatinine, Killip class, cardiac arrest, ST deviation, and enzyme flags. Returned before settlement; you are not charged.
400 invalid_flag boolean clinical flags must be true or false Returned before settlement; you are not charged.
400 invalid_items POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400 invalid_item_count items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400 invalid_item each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

  • TIMI risk score for STEMI — Compute the TIMI risk score for ST-elevation myocardial infarction from published bedside factors at presentation.
  • TIMI UA/NSTEMI — Compute the TIMI risk score for unstable angina / NSTEMI from age and six caller-assigned flags.
  • HEART score — Compute the HEART score as age points plus caller-assigned history, ECG, risk factors, and troponin (each 0-2).
  • Killip — Return the Killip and Kimball 1967 myocardial-infarction heart-failure class 1-4 from a caller-assigned integer, with the published class description and 1967 CCU hospital mortality.
  • ORBI — Sum the Auffret 2018 ORBI predictors after STEMI primary PCI and return the integer score (0-36), class I-IV, and derivation-cohort in-hospital cardiogenic-shock percent.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

  • HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
  • exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
  • HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
  • Execution is timeout-bounded and concurrency-capped.
  • Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.