Which risk score is generally more predictive of mortality in ACS and is often used to guide invasive strategies and disposition?

• A. GRACE score
• B. TIMI score
• C. APACHE II
• D. CHA2DS2-VASc

Answer: (A)

In ACS, predicting mortality helps decide how aggressively to treat and where to place a patient. The GRACE score is generally more predictive of mortality than the other common risk scores and is frequently used to guide invasive strategies and disposition. It was developed from large ACS cohorts and combines multiple clinically meaningful factors that reflect both the patient’s baseline risk and the acute severity of the event. Specifically, it includes age, heart rate, systolic blood pressure, creatinine (renal function), Killip class (heart failure on presentation), whether there was cardiac arrest at presentation, ST-segment deviation, and elevated cardiac enzymes. This mix of chronic and acute data gives GRACE stronger discrimination for in-hospital and 6-month mortality across STEMI and NSTEMI than scores that focus on fewer domains.

Because of this, a higher GRACE score points toward more urgent catheterization and aggressive management, while a lower score can support more conservative pathways. In contrast, TIMI is helpful but generally less predictive of mortality in ACS, APACHE II is a broad ICU severity score not specific to ACS, and CHA2DS2-VASc is used to estimate stroke risk in atrial fibrillation, not mortality risk in ACS.