GRACE, HEART and TIMI score Mnemonics : Cardiac Chest Pain Risk Stratification

GRACE Score

Mnemonic: GRACE

A. Global Registry of Acute Coronary Events

B. Renal: Creatinine

C. Age

D. Cardiac:

• Heart rate
• Systolic blood pressure
• Cardiac arrest at admission
• Killip class:
  • I – No CHF
  • II – Basal rales and/or JVD
  • III – Pulmonary edema
  • IV – Cardiogenic shock

E. ECG and Enzyme:

• ST segement deviation on ECG
• Abnormal cardiac enzymes

For GRACE 6 month risk score:

2 varibales are not used:

1. Killip class
2. Cardiac arrest at admission

3 other variables are used:

1. History of congestive heart failure
2. History of myocardial infarction
3. No in-hospital PCI

HEART score

Mnemonic: HEART

a. History:

• 2: Highly suggestive of cardiac origins
• 1: Moderately suspicious
• 0: Slightly suspicious

b. ECG:

• 2: Significant ST depression
• 1: Non-specific repolarization differences
• 0: Normal

c. Age:

• 2: >65 years
• 1: 45-65 years
• 0: <45 years

d. Risk factors:

• 2: 3 or more risk factors or history of atherosclerotic disease
• 1: 1-2 risk factors
• 0: No known risk factors

e. Troponin:

• 2: >3 x normal limit
• 1: 1-3 x normal limit
• 0: Within normal limit

Interpretation:

HEART score <4: Low risk (0.9-1.7%) of Major Adverse Cardiac Events (MACE) at 6 weeks (Can be considered for direct ED discharge or early discharge)

HEART score 4-6: Moderate risk (12-16.6%) of MACE at 6 weeks (Recommend admission for medical optimization and further workup)

HEART score >6: High tisk (50-65%) of MACE at 6 weeks (Recommend advancing for early coronary angiogram)

TIMI Score

Mnemonic: AMERICA

1. Age (greater than 65 years)
2. Markers (raised serum cardiac markers)
3. ECG (ST segment depression ≥0.5 mm at presentation)
4. Risk factors (atleast 3 for coronary artery disease)
5. Ischemia (atleast 2 anginal events previous 24 hours)
6. Coronary stenosis (prior stenosis of 50% or more)
7. Aspirin (use in previous 7 days)

1 point for each risk factor (maximum score 7).

Interpretation:

1. Low risk: 0-2
2. Intermediate risk: 3-4
3. High risk: 5-7