Which score is most commonly used to guide invasive strategy decisions in ACS?

• A. GRACE score
• B. Wells score
• C. CHADS2
• D. MELD

Answer: (A)

Risk stratification in ACS guides who should undergo invasive evaluation and potential revascularization. The GRACE score is the most commonly used tool for this purpose because it estimates the patient’s risk of in-hospital and short-term mortality using readily available admission data: age, heart rate, systolic blood pressure, creatinine, presence of cardiac arrest at presentation, ST-segment deviation, elevated cardiac enzymes, and Killip class. This combination reflects both hemodynamic status and extent of myocardial injury, which helps clinicians decide how aggressively to pursue invasive strategies like early coronary angiography and possible revascularization. Higher GRACE scores indicate greater risk and a higher likely benefit from invasive management, while lower scores may support a more conservative approach.

Wells score, CHADS2, and MELD serve different purposes: Wells assesses pretest probability for pulmonary embolism or deep vein thrombosis; CHADS2 estimates stroke risk in atrial fibrillation and guides anticoagulation; MELD evaluates liver disease severity and transplant risk. None of these are specifically validated for guiding invasive decisions in ACS.