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Essence of this Article

Several major medical registries and non-interventional studies have been launched to assess real-world outcomes in patients with acute coronary syndrome (ACS). These registries include: GRACE – Global Registry of Acute Coronary Events; Euro Heart Survey on ACS; and ACTION Registry–Get with the Guidelines (GWTG).

ACS Registries

Several major medical registries have been launched to assess real-world outcomes in patients with ACS. These registries include:

  • GRACE – Global Registry of Acute Coronary Events
  • Euro Heart Survey on ACS
  • ACTION Registry–Get with the Guidelines (GWTG)

Global Registry of Acute Coronary Events (GRACE) registry

  • Objective: to track the outcomes of patients presenting with ACS
  • Large, ongoing, observational registry, launched in 1999
  • Involves over 100,000 patients who have presented to 247 hospitals in 30 countries, including those in North America, South America, Europe, Asia and Australia
  • Incorporates the data from the first 10–20 consecutive cases that present with qualifying symptoms plus evidence of coronary artery disease each month at each centre, and follows these patients for 6 months

GRACE provides data on:

  • Demographics
  • Symptoms at presentation
  • Management
  • Outcomes
  • Guideline compliance rates336
  • Risk factors for adverse or fatal outcomes337, 338

The GRACE ACS risk model score;339 which has been validated extensively, was incorporated into the 2007 European Society of Cardiology (ESC) guidelines for the treatment of patients with non-ST-elevation myocardial infarction (NSTEMI).340

For more information visit:

Centre for Outcomes Research. http://www.outcomes-umassmed.org/GRACE/default.aspx
GRACE risk score calculator. http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html

Related key publications:

GRACE ACS risk model publications:

Fox KA, Dabbous OH, Goldberg RJ et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006;333:1091. [PubMed].
Granger CB, Goldberg RJ, Dabbous O et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345–2353. [PubMed].
Eagle KA, Lim MJ, Dabbous OH et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004;291:2727–2733. [PubMed].

Publications utilizing GRACE registry data

Grace bibliography. http://www.outcomes-umassmed.org/GRACE/bibliography.aspx

Euro Heart Survey ACS Registry

  • Objectives: to document the current presentation of ACS in Europe and to determine the adherence to current ESC guidelines for the management of the different kinds of ACS:
    • Acute reperfusion treatment (ST-elevation myocardial infarction [STEMI])
    • Invasive versus conservative treatment (NSTEMI/unstable angina)
    • Adjunctive medical treatment (all ACS)

The first Euro Heart Survey ACS Registry collected data on 10,484 patients with ACS between September 2000 and May 2001. The survey assessed a number of in-hospital and 30-day outcomes for these patients, including:

  • Correlation between initial and final diagnoses
  • Diagnostic and therapeutic modalities
  • In-hospital complications
  • Post-discharge event rates and mortality rates341

The second registry collected data on 6385 patients with ACS between March and October 2004. The survey enabled the assessment of temporal trends in the diagnosis, management, and outcomes of ACS (in-hospital and 30-day follow-up), while comparing the results with those from the initial survey342

The third registry collected data on 21,582 consecutive patients between October 2006 and October 2008. After 1 year follow-up, the immediate, in-hospital and 1-year outcome of patients with ACS were assessed, which included the following factors:

  • Gender disparities in the management and outcomes in patients presenting with acute myocardial infarction (MI)343
  • Performance measures (such as appropriate and timely therapy use) in STEMI and their result on patient outcomes344
  • Validation of the Killip classification in patients presenting with ACS345
  • The determinants of stroke and its impact on the outcomes of patients with presenting with an ACS event346
  • Patient demographics, subsequent intervention/therapy use and clinical outcome347

For more information visit:

European Society of Cardiology. http://www.escardio.org/Guidelines-&-Education/Trials-and-Registries/Observational-registries-programme/Euro-Heart-Survey.

Related key publications:

Euro Heart Survey ACS Bibliography. 2012. Available at: http://www.escardio.org/guidelines-surveys/ehs/acute-coronary-syndromes/Pages/acs-publications.aspx. Accessed 18 July 2012.

ACTION Registry–GWTG

ACTION Registry–GWTG is an ongoing national registry created in 2007 by the merger of the National Cardiovascular Data Registry (NCDR) ACTION Registry from the American College of Cardiology (ACC) Foundation and the GWTG-Coronary Artery Disease (CAD) Program from the American Heart Association (AHA)

  • Objectives: to record information on:
    • Treatment patterns
    • Clinical outcomes
    • Drug safety
    • Overall quality of care (measured by adherence to ACC/AHA clinical guidelines) provided to patients with STEMI and NSTEMI
  • Includes detailed clinical information on >147,000 patients with STEMI or NSTEMI in 383 participating US hospitals348

The registry has determined:

  • The extent to which numerous factors, such as age349 and gender,350 can influence patient outcomes
  • Ethnic differences in treatment patterns in patients presenting with STEMI351
  • The bleeding risk of patients presenting with MI who were treated with anticoagulant therapy352

Models of in-hospital bleeding353 and in-hospital mortality354 have also been developed by the ACTION Registry–GWTG group.

For more information visit:

National Cardiovascular Data Registry. http://www.ncdr.com/webncdr/ACTION/Default.aspx

Related key publications:

Peterson ED, Roe MT, Chen AY et al. The NCDR ACTION Registry-GWTG: transforming contemporary acute myocardial infarction clinical care. Heart 2010;96:1798–1802. [PubMed].
Kadakia MB, Desai NR, Alexander KP et al. Use of anticoagulant agents and risk of bleeding among patients admitted with myocardial infarction: a report from the NCDR ACTION Registry–GWTG (National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines). JACC Cardiovasc Interv 2010;3:1166–1177. [PubMed].


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