Strategies of patient care in acute coronary syndromes: rationale for the Global Registry of Acute Coronary Events (GRACE) registry.

An abundance of evidence is available from large, randomized clinical trials supporting the efficacy of therapies for the management of patients with acute coronary syndromes. For ST-segment elevation myocardial infarction (MI), a variety of databases can be used to assess how these therapies, both pharmacologic and invasive, are being integrated into real practice. Little information is available, however, with regard to how newer treatments are actually being implemented for patients with unstable angina and non-ST-segment elevation MI. There are several important issues to consider in evaluating current treatment practices for acute coronary syndromes, including limitations of clinical trial databases, a trend toward progressive shortening of length of hospital stay, and variations in the availability of resources among treatment centers. In response to the need for a broader database that would address the global impact of clinical management practices in acute coronary syndromes, the Global Registry of Acute Coronary Events (GRACE) Registry has been established. The GRACE Registry will initially collect data on patient care from a variety of treatment centers in 14 countries, the plan being to eventually enroll 10,000 patients per year. This international observational database will obtain information on the complete spectrum of acute coronary syndromes, with the specific goals of describing diagnostic and treatment strategies, determining hospital outcomes, improving quality of care, and developing hypotheses for future clinical research.