title: The expanded Global Registry of Acute Coronary Events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes.
abstract: BACKGROUND
  The Global Registry of Acute Coronary Events (GRACE)-a prospective, multinational study of patients hospitalized with acute coronary syndromes (ACSs)-was designed to improve the quality of care for patients with an ACS. Expanded GRACE aims to test the feasibility of a simplified data collection tool and provision of quarterly feedback to index individual hospital management practices to an international reference cohort.
  
  
  METHODS
  We describe the objectives; study design; study and data management; and the characteristics, management, and hospital outcomes of patients > or =18 years old enrolled with a presumptive diagnosis of ACS.
  
  
  RESULTS
  From 2001 to 2007, 31,982 patients were enrolled at 184 hospitals in 25 countries; 30% were diagnosed with ST-segment elevation myocardial infarction, 31% with non-ST-segment myocardial infarction, 26% with unstable angina, and 12% with another cardiac/noncardiac final diagnosis. The median age was 65 (interquartile range 55-75) years; 24% were >75 years old, and 33% were women. In general, increases were observed over time across the spectrum of ACS (1) in the use in the first 24 hours and at discharge of aspirin, clopidogrel, beta-blockers, and angiotensin-converting enzyme inhibitors/receptor blockers; (2) in the use at discharge of statins; (3) in the early use of glycoprotein IIb/IIIa inhibitors and low-molecular-weight heparin; and (4) in the use of cardiac catheterization and percutaneous coronary intervention. An increase in the use of primary percutaneous coronary intervention and a similar decrease in the use of fibrinolysis in ST-segment elevation myocardial infarction were also seen.
  
  
  CONCLUSIONS
  Over the course of 7 years, general increases in the use of evidence-based therapies for ACS patients were observed in the expanded GRACE.
authors.affiliation: Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, 30 Bond St, Room 6-034 Queen, Toronto, Ontario M5B 1W8, Canada. goodmans@smh.toronto.on.ca
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Brian M
authors.initials: BM
authors.lastname: Kennelly
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
mesh_terms: D054058:Acute Coronary Syndrome / Q000178:diet therapy / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D001026:Coronary Artery Bypass; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012042:Registries / Q000592:standards; D012107:Research Design; D016896:Treatment Outcome