Scoring Systems

There are 2 main used: TIMI and GRACE.  Online calculators are available for both:



Grace is also available to download for iPhone/iPad app: follow the link above.


NICE Guidelines: Unstable Angina

Take home points for the ED

  • assess cardiovascular risk using a recognised scoring system eg TIMI or GRACE (see links below)
  • Bloods (including troponins at time of presentation if ECG changes- but don’t use to exclude ACS!)
  • Offer aspirin 300mg to everyone except those with hypersensitivity – then consider clopidogrel
  • Offer clopidogrel if >=1.5% predicted 6 month mortality
  • Offer fondaparinux to patients without a high bleeding risk unless angiography is planned within 24 hours
  • Offer unfractionated heparin if angiography is likely within 24 hours