title: Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up.
abstract: OBJECTIVE
  Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality.
  
  
  METHODS
  Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites.
  
  
  RESULTS
  From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), beta-blocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re)infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80).
  
  
  CONCLUSIONS
  In this large multinational cohort of acute coronary syndrome patients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained.
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Sami M A
authors.initials: SM
authors.lastname: Alnasser
authors.affiliation: Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.affiliation: INSERM U-698, Université Paris 7, Centre Hospitalier Bichat-Claude Bernard, Paris, France.
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: University of Michigan Health System, Ann Arbor.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, United Kingdom.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: ICYCC Favaloro Foundation, Buenos Aires, Argentina.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gurfinkel
authors.affiliation: Concord Hospital and University of Sydney, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: Department of Internal Medicine, Krankenhaus der Barmherzigen Bruder, Teaching Hospital of the Karl Franzens University Graz, Graz, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Klein
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: van de Werf
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Avezum
authors.affiliation: Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (AP-HP), Univ Paris 06, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Department of Cardiology, KKO St. Marien-Hospital, Oberhausen, Germany.
authors.forename: Dietrich C
authors.initials: DC
authors.lastname: Gulba
authors.affiliation: Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.affiliation: Hospital Universitario La Paz, Instituto de Investigación La Paz, IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez-Sendon
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: Hoag Memorial Hospital Presbyterian, Newport Beach, Calif.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Kennelly
authors.affiliation: Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Canadian Heart Research Centre, Toronto, Ont., Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Fleming
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; Canadian Heart Research Centre, Toronto, Ont., Canada. Electronic address: goodmans@smh.ca.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017677:Age Distribution; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D002423:Cause of Death; D003266:Continuity of Patient Care; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D017052:Hospital Mortality; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute coronary syndromes; Coronary revascularization; Prognosis; Risk stratification