Study note
MedicineCardiology

GRACE risk examples, Killip classes and myocardial salvage

THE CONTEXT
The GRACE score is used for risk stratification in acute coronary syndrome. The passage illustrates estimated in-hospital mortality and describes Killip classes and the evolution of myocardial infarction.

Illustrative GRACE scores

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A 65-year-old patient with Killip class II, systolic blood pressure of 99 mmHg, heart rate of 100 beats/min, serum creatinine of 76 μmol/L, ST-segment deviation and elevated cardiac troponin, without cardiac arrest at admission, has a score of 195 and approximately 16% risk of in-hospital death.
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A 55-year-old patient with Killip class I, systolic blood pressure of 80 mmHg, heart rate of 60 beats/min, serum creatinine of 30 μmol/L and no additional risk factors has a score of 103 and approximately 0.9% risk of in-hospital death.

Killip classification

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Killip class categorises heart failure severity using readily obtained clinical signs.
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Class I indicates no heart failure; class II indicates crackles audible halfway up the chest.
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Class III indicates crackles throughout all lung fields; class IV indicates cardiogenic shock.

Creatinine conversion

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Divide creatinine in μmol/L by 88.4 to convert it to mg/dL.

Time course of myocardial infarction

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The relative proportions of ischaemic, infarcting and infarcted tissue change slowly over 12 hours.
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Early in myocardial infarction, a significant proportion of the myocardium in jeopardy is potentially salvageable.
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