• Siegbert Stracke, Oliver Dörr, Martin C Heidt, Dursun Gündüz, Christiane Neuhof, Mariana Parahuleva, Harald Tillmanns, and Ali Erdogan.
• Department of Angiology, University Clinic Giessen, Germany.
• Clin Res Cardiol. 2010 Oct 1; 99 (10): 627-31.

IntroductionChest pain and chest discomfort are common problems in the acute care setting. Life-threatening causes of chest pain must be quickly differentiated from other less serious causes. There is a need to stratify risk rapidly in patients presenting to the emergency department (ED) with chest pain. This study evaluates the relationship between the GRACE risk score (GRS) and in-hospital mortality in patients presenting to the ED with chest pain of all causes.MethodsWe conducted a prospective study of a consecutive sample of 1,014 patients with chest pain and chest discomfort presenting to the medical ED of the University Clinic in Giessen, Germany. The GRS was calculated for each patient at admission. Additionally, the reason for admission into the hospital and the diagnosis on discharge or diagnosis of death were recorded. The relative risk between the risk groups was assessed, and the functional dependency between the GRS and observed in-hospital death was analyzed.ResultsA total of 94 patients died during the stay in the hospital, 83 patients with high risk, 9 with medium risk, and 2 with low risk. The risk of in-hospital death was 24.5% for high-risk patients, 2.6% for medium-risk patients, and 0.6% for patients with low risk. The correlation between the GRS and in-hospital mortality is strongly positive (p < 0.01).ConclusionThis study shows that the GRS accurately stratifies risk of intra-hospital mortality in patients presenting to the ED with chest pain and can guide patient triage and management.

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