1. Global Registry of Acute Coronary Events Assessing Today’s Practice Patterns to Enhance Tomorrow’s Care
Acute coronary syndromes (ACS) represent a broad spectrum of conditions from the standpoint of diagnosis, treatment and prognosis. They range from unstable angina (UA) to non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
Use of fibrinolytic agents for patients with STEMI, combined with the use of other medical therapies such as low-molecular-weight heparin, unfractionated heparin, aspirin, and platelet inhibitors, have been shown to improve the outcomes for patients with ACS. However, no systematic studies have been carried out to characterize the prevalence of ACS, or to evaluate the clinical characteristics of patients with ACS or their routine daily management, especially from a worldwide perspective.
In 1997, in response to the gap in understanding of ACS, discussions began about setting up a study into the management and outcomes of ACS patients. By early 1999, a pilot study was under way, which tested the feasibility of the project, and evaluated the data-collection methods and the case-report form. By mid-1999 the study, known as GRACE, or the Global Registry of Acute Coronary Events, was launched.
Supported by an unrestricted educational grant from sanofi-aventis to the Center for Outcomes Research University of Massachusetts Medical School

2. What is GRACE? Global Registry of Acute Coronary Events
Largest multinational registry covering the full spectrum of ACS
Generalizable patient inclusion criteria
In-hospital and 6-month follow-up
Representative of the catchment population: (clusters of hospitals)
Full spectrum of hospitals and facilities
Training, audit and quality control

3. International Scientific Advisory Committee
International Advisory Committee
‘Americas’ clusters
Chair: JM Gore
‘European’ clusters
Chair: KAA Fox
8 advisors
8 advisors
The International Advisory Committee for GRACE comprises the principal investigator from each of the 16 clusters. Two Co-Chairs have been elected, one of whom oversees clusters in the ‘Americas’ and the other the non-American clusters. There are nine advisors and 40 subsite cardiologists for the ‘European’ clusters, and eight advisors and 41 subsite cardiologists for the ‘Americas’ clusters.
40 subsite cardiologists
40 subsite cardiologists

4. Scientific Advisory Committee
Co-Chairs Keith AA Fox, UK
Joel M Gore, USA
Publications Kim A Eagle, USA
Co-Chairs Ph Gabriel Steg, France
Study Co-ordination Fred Anderson, University of Massachusetts
Argentina
Enrique Gurfinkel
Australia/New Zealand
David Brieger
Austria
Georg Gaul
Belgium
Frans J Van de Werf
Brazil
Álvaro Avezum
Canada
Shaun Goodman
Germany
Dietrich C Gulba
Italy
Giancarlo Agnelli
France
Gilles Montalescot
Ph Gabriel Steg
Poland
Andrzej Budaj
Spain
José López-Sendón
United Kingdom
Keith AA Fox
Marcus Flather
United States
Frederick A Anderson
Kim A Eagle
Robert J Goldberg
Joel M Gore
Christopher B Granger
Brian M Kennelly

5. Objectives of GRACE
Identify opportunities to improve the quality of care for patients with ACS
Describe diagnostic & treatment strategies, & hospital & post-discharge outcomes
Develop hypotheses for future clinical research
Disseminate findings to a wider audience
The goal of GRACE is to improve the medical treatment of patients with ACS through better understanding of patient demographics, management, and in-hospital and post-discharge outcomes.
The objectives of GRACE are to:
Provide detailed data to the medical community to characterize current and evolving practice patterns, delivery of care, and resource utilization in the management of ACS.
Provide data to support internal and external standards and benchmarking of treatment patterns and patient outcomes.
Analyze the data collected in the GRACE database and design ancillary studies to address unanswered clinical questions.
Disseminate findings through the publication of manuscripts in peer-reviewed medical journals.

6. Core GRACE Study Design
~100 hospitals in 14 countries
Europe, North & South America, Australia, New Zealand
Population-based clusters with community hospitals and referral centres
First consecutive cases per centre/month: qualifying symptoms PLUS evidence of CAD
Random audit of all centres: 3 year cycle

7. Cluster Strategy for Study Sites: Population-Based Design2 1 3
18 advisory
committee
members
~100 hospitals
~10,000 ACS
patients/year
Currently, 84 hospitals organized into 17 geographic clusters, each of which is led by a member of the International Advisory Committee, are participating in GRACE. These 17 regions were chosen to reflect the type of care received by patients with ACS in populations that vary according to demographic, clinical and treatment characteristics.1
The design of GRACE is such that an unbiased and generalizable sample of patients with ACS is enrolled within each of the 17 locations. For each hospital, the first 10–20 qualifying cases (depending on the hospital size) discharged each month are enrolled in the registry. This approach results in approximately 120 cases per hospital being enrolled each year.
1. The GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J 2001;141:190–9. 6 4 5

8. Multinational Site Network
Argentina 6 sites
Australia 7 sites
Austria site
Belgium 6 sites
Brazil 7 sites
Canada 6 sites
France 6 sites
Germany 5 sites
Italy 5 sites
New Zealand 2 sites
Poland 6 sites
Spain 4 sites
UK 5 sites
USA 18 sites
Currently, 84 hospitals organized into 17 geographic clusters in 14 countries are participating in GRACE. These 17 regions were chosen to represent the type of care received by ACS patients in populations that varied according to patient demographics, and clinical and treatment characteristics.

9. 89 Active Core Study Sites: 17 Clusters in 14 Countries
Eighty-four study sites in 14 countries spanning four continents – North and South America, Europe, and Australia and New Zealand – are involved in recruiting patients for GRACE. Data collection began in April 1999, with the aim of enrolling 10,000 patients with ACS each year.

10. Status of 17 Core Clusters
70,359 cases enrolled
85% six-month follow-up
As of June 2007, 84 hospitals located in 14 countries across four continents are involved in enrolling patients in GRACE. A total of 66,456 case-report forms have been received, and the post-discharge follow-up rate is 85%. One hundred five abstracts have been presented or have been accepted for presentation at major cardiology meetings, and sixty-three manuscripts have been published in peer-reviewed journals or are in press.
Q4-2007

11. The “Big Picture” Core GRACE & GRACE2
GRACE Core
Substudy 1
Substudy 2
Substudy 3
The ongoing GRACE expansion, or GRACE2, has been launched to enable hospitals in countries that are not involved in the core GRACE study to participate in the project. As of August 2001, 158 hospitals in 23 countries – Australia, Austria, Bangladesh, Brazil, Bulgaria, Canada, China, Colombia, Ecuador, El Salvador, Guatemala, Italy, Latvia, Panama, Peru, Poland, Portugal, Romania, Ukraine, United Arab Emirates, United States, Uruguay, Venezuela – are actively enrolling patients in GRACE2. An additional 100 sites are expected to join the study.
All publications arising from the GRACE database and any substudies will remain under the auspices of the core GRACE investigators.
GRACE Core
70,359 patients
89 hospitals
14 countries
GRACE2
31,982 patients
158 hospitals
23 countries

12. 247 Core GRACE & GRACE2 Study Sites in 30 Countries*
Eighty-four study sites in 14 countries spanning four continents – North and South America, Europe, and Australia and New Zealand – are involved in recruiting patients for GRACE. Data collection began in April 1999, with the aim of enrolling 10,000 patients with ACS each year.
*30 countries = 16 GRACE2 + 7 core GRACE + 7 both

13. Status: December 31, 2007 89 Core & 158 Expanded Sites
30 countries
247 hospitals
102,341 cases
As of June 2007, 84 hospitals located in 14 countries across four continents are involved in enrolling patients in GRACE. A total of 66,456 case-report forms have been received, and the post-discharge follow-up rate is 85%. One hundred five abstracts have been presented or have been accepted for presentation at major cardiology meetings, and sixty-three manuscripts have been published in peer-reviewed journals or are in press.
Q4-2007

14. Internet Website www.outcomes.org/grace

15. Hospital Characteristics Q4-2001 vs. Current Quarter
Q Q4-2007
Number of Hospitals
Coronary care unit 94% %
Emergency department 86% %
Cardiac catheterization laboratory % %
Open heart surgery % %
Hospital beds (mean)
Coronary care unit beds (mean)
ACS admissions (mean, per year)
The majority of hospitals involved in GRACE have a coronary care unit and an emergency department. Over two-thirds of hospitals have access to cardiac catheterization facilities and one-half perform open heart surgery. The mean number of hospital beds is over 500, and the mean number of beds in the coronary care unit is 11. Each year, an average of over 600 patients are admitted to each hospital for suspected ACS.
Q4-2007

16. 70,359 Cases Enrolled as of December 31, 2007
Q4-2007

17. Classification of Cases
The most common diagnosis for patients with ACS enrolled in the GRACE study is STEMI, with around one-third of patients hospitalized with the condition. The second most common category of ACS is NSTEMI at 30%, followed by UA at 29%. A minority of patients were diagnosed with ‘other cardiac’ or ‘noncardiac’ diagnoses.
Q4-2007

18. Hospital Discharge Status
STEMI NSTEMI UA
Death 7% 4% 3%
Home 77% 78% 87%
Transfer * 10% 12% 9%
Other 6% 6% 2%
*Transfer to another acute care hospital.
Q4-2007

19. Admission versus Final DiagnosisUA
N=4999
(44%)
‘Rule-out’ MI
N=957
(9%)
Unspecified chest pain
N=745
(7%)
Other cardiac
N=381
(3%)
Non-cardiac
N=125
(1%)
STEMI
N=3419
(30%)
Non-STEMI
N=2893
(25%)
Unstable angina
N=4397
(38%)
N=508
(4%)
N=326 MI
N=4100
(36%)
*Missing diagnosis in 236 patients
Admission diagnoses versus final diagnoses (derived from discharge diagnosis, electrocardiographic changes and cardiac enzymes) in 11,543 patients with acute coronary syndromes. Figures expressed as percentage of total ACS.
Fox KAA et al.Eur Heart J 2002;23:

20. Baseline Characteristics
STEMI NSTEMI UA (n = 13,862) (11,316) (12,509)
Median age (years)
Male (%)
Prior history (%)
Angina
Myocardial infarction
PCI/CABG 8/5 15/14 25/19
Smoking
Diabetes mellitus
Hypertension
Hyperlipidemia
Participant in clin trial (%)

21. Hospital Treatment According to Admission Diagnosis
MI UA ? MI Chest pain
n , , , ,266
% % % %
ACE inhibitors
Aspirin
-blockers
Ca2+ blockers
Gp IIb/IIIa: no PCI
Gp IIb/IIIa with PCI
LMWH
UFH
Thrombolytic agents

22. Diagnostic Procedures

23. Hospital Cardiac Interventions According to Final Diagnosis
Intervention STEMI NSTEMI UA
n , , ,509
% % %
Cardiac catheterization
PCI
CABG 4 7 6

24. Treatments at Discharge
STEMI NSTEMI UA
n , , ,509
% % %
ACE inhibitors
Aspirin
-blockers
Ca2+ blockers
Statins
Warfarin

25. Hospital Outcome by Final Diagnosis

26. Hospital Outcomes <0.0001 10.7 <0.0001 5.6 5.6 4.0
Lankes W et al.Eur Heart J 2002;23(Abstr Suppl):502.

27. What proportion of eligible patients receive reperfusion therapy?

28. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE)
Kim A. Eagle, Shaun G. Goodman, Álvaro Avezum, Andrzej Budaj, Cynthia M. Sullivan, José López-Sendón, for the GRACE Investigators
Lancet 2002;359:373-77

29. Missed Opportunities for Reperfusion
ST ↑ or LBBB, <12 hrs from onset, no contraindications
ANC (%) US (%) AB (%) EUR (%) n
PCI alone
Lytic alone
Both
Neither
AB, Argentina/Brazil; ANC, Australia/New Zealand/Canada; EUR, Europe; US, United States
Eagle KA et al. Lancet 2002;359:373-7.

30. Independent Predictors of No Reperfusion
Variable OR (95% CI)
Prior CABG ( )
History of diabetes ( )
History of congestive heart failure ( )
Presentation without chest pain ( )
*Age 75 years ( )
*As compared to the <55 years age group
Eagle KA et al. Lancet 2002;359:373-7.

31. Geographical Variation: Admission to Hospitals with/without Access to Cath Lab
ANC, Australia/New Zealand/Canada; AB, Argentina/Brazil

32. Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: Insights from the Global Registry of Acute Coronary Events (GRACE)
Andrzej Budaj, David Brieger, Ph Gabriel Steg, Shaun G. Goodman, Omar H. Dabbous, Keith A. A. Fox, Álvaro Avezum, Christopher P. Cannon, Tomasz Mazurek, Marcus D. Flather, and Frans Van De Werf, for the GRACE Investigators
Am Heart J 2003;146:

33. Geographic Practice Variation
Budaj A et al. Am Heart J 2003;146:

34. Antithrombotic Rx Used
Cannon CP et al.Eur Heart J 2001;22(Abstr Suppl):592.

35. Incidence of Major Bleeding
Cannon CP et al.Eur Heart J 2001;22(Abstr Suppl):592.

36. Multivariate Adjusted Odds of Major Hemorrhage
3.9%
2.4%
8.3%
2.9%
UFH
LMWH
UFH + IIb/IIIa
LMWH +
IIb/IIIa
OR=0.55
P<0.001
OR=2.26
The baseline characteristics of the population were well matched between the three treatment groups. Mean age was 60, 25% were female, 56% of patients had an MI at presentation and 9% presented with signs of congestive heart failure defined by Killip class. One quarter had the onset of ACS within 24 hours
Lower
Higher
Cannon CP et al.Eur Heart J 2001;22(Abstr Suppl):592. 4

37. Safety Events 
Cannon CP et al.Eur Heart J 2001;22(Abstr Suppl):592.

38. Major Cardiac Events
Cannon CP et al.Eur Heart J 2001;22(Abstr Suppl):592.

39. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE)
M. Moscucci, K.A.A. Fox, Christopher P. Cannon, W. Klein, José López-Sendón, G. Montalescot, K. White, R.J. Goldberg, for the GRACE Investigators
European Heart Journal 2003;24:

40. Incidence of Major Bleeding
Moscucci M et al.Eur Heart J 2003;24:

41. Predictors of Major Bleed
Variables Overall UA STEMI NSTEMI
Age (per 10 year ↑) x x x x
Female gender x x x
History of renal insufficiency x x x
History of bleeding x x x x
Killip Class IV x MAP (per 20 mmHg ↓) x x
IV Inotropics x x x x
Other vasodilators x x
Thrombolytics x x
Diuretics x x x x
Unfractionated heparin x x
IIb/IIIa receptor blockers x x x
PA catheters x x x x
PCI x x x
Thrombolytics and IIb/IIIa inhib x x x
Moscucci M et al.Eur Heart J 2003;24:

42. In-Hospital Mortality Rates** ** ** **
**P<0.001
Moscucci M et al.Eur Heart J 2003;24:

43. Outcome of “Low-risk” Patients with ACS
Presentation with UA in the absence of dynamic ECG changes, no troponin elevation, no arrhythmia nor hypotension
Abnormal ECG in 38%,
27% stress test, 37% echo, 52% angio
6 month outcome:
23% readmission
12% revascularized
3% deaths
“Low-risk” is not no risk
Devlin et al.Eur Heart J 2001;22(Abstr Suppl):525.

44. Evidence Based Medicine
Total Population = 9,980
ST  MI Non- ST  MI UA % of pts who are
Therapy (n=2,501) (n=2,504) (n=3,631) eligible
ASA X X X
B blocker X X
ACE-I X X
Reperfusion X
GP IIb/IIIa/LMWH X X
Granger CB et al. J Am Coll Cardiol 2001;37(2 Suppl A):503A.

45. GRACE: Use of EBM in “Eligible” Patients
14%
PTCA
14%
IIb/IIIa
56%
lytics
48%
LMWH
n=5,373
n=4,480
n=3,254
n=1,963
n=4112
Granger CB et al. J Am Coll Cardiol 2001;37(2 Suppl A):503A.

46. Management of acute coronary syndromes
Management of acute coronary syndromes. variations in practice and outcome: Findings from the Global Registry of Acute Coronary Events (GRACE)
K.A.A. Fox, S.G. Goodman, W. Klein, D. Brieger, P.G. Steg, O. Dabbous and Á. Avezum for the GRACE Investigators
Eur Heart J 2002;23:

47. Geographic Practice Variation: Discharge Medication
AT/AC, antithrombin or anticoagulant
Fox KAA et al. Eur Heart J 2002;23:

48. n=3420 of 8213 with CK, CK-MB & troponin measurements
Increase in Diagnosis of MI Utilizing Troponin
n=3420 of 8213 with CK, CK-MB & troponin measurements
The most common diagnosis for patients with ACS enrolled in the GRACE study is UA, with around one-third of patients hospitalized with the condition. The second most common category of ACS is STEMI at 31%, followed by NSTEMI at 28%. A minority of patients were diagnosed with ‘other cardiac’ or ‘noncardiac’ diagnoses.
Goodman SG et al. J Am Coll Cardiol 2001;37(2 Suppl A):358A.

49. In-Hospital Mortality
OR & 95% CI
n=1111 *
( )
n=900
n=124 *
( )
( )
The most common diagnosis for patients with ACS enrolled in the GRACE study is UA, with around one-third of patients hospitalized with the condition. The second most common category of ACS is STEMI at 31%, followed by NSTEMI at 28%. A minority of patients were diagnosed with ‘other cardiac’ or ‘noncardiac’ diagnoses.
Goodman SG et al. J Am Coll Cardiol 2001;37(2 Suppl A):358A .
*p<0.05

50. Impact of Aspirin on Presentation and Hospital Outcomes in Patients with Acute Coronary Syndromes (The Global Registry of Acute Coronary Events [GRACE])
Frederick A. Spencer, Jose J. Santopinto, Joel M. Gore, Robert J. Goldberg, Keith A.A. Fox, Mauro Moscucci, Kami White, and Enrique P. Gurfinkel
Am J Cardiol 2002;90:

51. Impact of Prior ASA on ACS: GRACE

52. Type of ACS and Hospital Mortality in Patients with History of CAD Stratified By Prior ASA
Impact of prior ASA on:
STEMI 0.52 (0.44,0.61)*
Death 0.69 (0.5,0.95)**
*Controlled for age, sex, medical hx, prior therapies, in hospital therapies
**Controlled for above plus MI type

53. Type of ACS and Hospital Mortality in Patients without History of CAD Stratified By Prior ASA
Impact of prior ASA on:
STEMI 0.35 (0.30,0.40)*
Death 0.77 (0.55,1.07)**
*Controlled for age, sex, medical hx, prior therapies, in hospital therapies
** Controlled for above plus MI type

54. Association of Statin Therapy with Outcomes of Acute Coronary Syndromes: The GRACE Study
Frederick A. Spencer, Jeanna Allegrone, Robert J. Goldberg, Joel M. Gore, Keith A.A. Fox, Christopher B. Granger, Rajendra H. Mehta and David Brieger for the GRACE Investigators*
Ann Intern Med 2004;140:

55. Prior and Early Utilization of Statins in Patients with ACS: GRACE
Ann. Intern Med. 2004;140:

56. Final Diagnosis of ACS Patients According to Previous Treatment with Statins
*Multivariate analysis: Prior statin users less likely to present with STEMI -OR 0.79 (0.71,0.88)
Ann. Intern Med. 2004;140:

57. Hospital Outcomes of ACS Patients Stratified by Statin Use
Outcome Prior statins Prior & Hospital Hospital Statins Only Statin Only
Death (0.91,2.14) (0.16,0.25) 0.38 (0.30,0.48)
Recurrent MI 0.69 (0.43,1.11) (0.75,1.07) 1.22 (1.08,1.37)
Stroke (0.43,2.73) (0.42, 1.12) 0.80 (0.57, 1.14)
Composite (0.74,1.41) (0.56,0.77) (0.78,0.97)
*Compared to patients never receiving statins
Ann. Intern Med. 2004;140:

58. Comparison of Outcomes of Patients With Acute Coronary Syndromes With and Without Atrial Fibrillation
Rajendra H. Mehta, Omar H. Dabbous, Christopher B. Granger, Polina Kuznetsova, Eva M. Kline-Rogers, Frederick A. Anderson, Jr., Keith A.A. Fox, Joel M. Gore, Robert J. Goldberg and Kim A. Eagle for the GRACE Investigators
Ann J Cardiol 2003;92:

59. Adjusted ORs for Hospital Events in Patients with ACS and New-Onset Atrial Fibrillation
AF Better
AF Worse
Major bleed
Stroke
Cardiac arrest
Pulmonary edema
Shock
Death      
Odds Ratio
Am J Cardiol 2003;92(9):1031-6

60. Adjusted ORs for Hospital Events in Patients with ACS and Previous
Atrial Fibrillation
AF Better
AF Worse
Major bleed
Stroke
Cardiac arrest
Pulmonary edema
Shock
Death      
Odds Ratio
Am J Cardiol 2003;92(9):1031-6

61. Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes: Observations From the Global Registry of Acute Coronary Events (GRACE)
Philippe Gabriel Steg, Omar H. Dabbous, Laurent J. Feldman, Alain Cohen-Solal, Marie-Claude Aumont, José López-Sendón, Andrzej Budaj, Robert J. Goldberg, Werner Klein, Frederick A. Anderson, Jr, for the Global Registry of Acute Coronary Events (GRACE) Investigators
Circulation. 2004;109:

62. Impact of Heart Failure on Admission on Hospital Mortality
>75 years
65-74 years
55-64 years
<55 years
3.1 (2.4,3.9)
3.3 (2.3,4.8)
5.0 (2.9,8.3)
10.1 (5.3,19.2)
Lower odds
ratio for death Higher odds of death
*Relative to patients without HF
Circulation 2004;109:

63. Death Rates from Hospital Admission to 6-Month Follow-Up for Patients According to Timing of Heart Failure
Circulation 2004;109:

64. Hospital Case-Fatality Rates According to Development of Heart Failure
Group HF (+) HF (-)
All patients 12.0% 2.9%
STEMI 16.5% 4.1%
Non-STEMI 10.3% 3.0%
Unstable angina % 1.6%
Circulation 2004;109:

65. Stenting and Glycoprotein IIb/IIIa Inhibition in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Findings From the Global Registry of Acute Coronary Events (GRACE)
Gilles Montalescot, Frans Van de Werf, Dietrich C. Gulba, Àlvaro Avezum, David Brieger, Brian M. Kennelly, Tomasz Mazurek, Frederick Spencer, Kami White, and Joel M. Gore for the GRACE Investigators
Catheterization & Cardiovascular Interventions. 60: (2003)

66. Probability of Survival at 6 Months (all PCI)
Death rates:
+GP +stent 7.3% +GP –stent 12.8%
-GP +stent 6.7% -GP – stent 14.4%
Montalescot G et al.Catheter Cardiovasc Interv 2003;60:360-7.

67. Probability of Survival at 6 Months (Primary PCI)
Death rates:
+GP +stent 7.7% +GP –stent 7.4%
-GP +stent 8.7% -GP –stent 20.1%
Montalescot G et al.Catheter Cardiovasc Interv 2003;60:360-7.

68. Six-Month Outcomes in a Multinational Registry of Patients Hospitalized With an Acute Coronary Syndrome (The Global Registry of Acute Coronary Events [GRACE])
Robert J. Goldberg, Kristen Currie, Kami White, David Brieger, Phillippe Gabriel Steg, Shaun G. Goodman, Omar Dabbous, Keith A.A. Fox and Joel M. Gore for the GRACE Investigators
Am J Cardiol 2004;93:

69. Six-Month Follow-Up* Death 5% (480/9414) 6% (496/7977) 4% (349/9357)
STEMI NSTEMI UA
Death 5% (480/9414) 6% (496/7977) 4% (349/9357)
Stroke 1% (110/9173) 1% (103/7749) 1% (79/9176)
Rehospitalized 18% (1619/9147) 19% (1501/7721) 19% (1761/9150)
*Excluding events that occurred in hospital
Goldberg RJ et al.Am J Cardiol 2004;93:

70. Discharge to 6 Month Outcomes: Cardiac Interventions
Scheduled and unscheduled procedures
Goldberg RJ et al.Am J Cardiol 2004;93:

71. 6 Month Follow-up
Cannon CP et al.Eur Heart J 2001;22(Abstr Suppl):592.

72. Total Outcomes: Admission to 6 Months

73. Survival Rate 6 Months Post Discharge for STEMI, NSTEMI, and UA Patients
Goldberg RJ et al.Am J Cardiol 2004;93:

74. Factors Associated With An Increased Risk of Post-Discharge Death
Characteristic STEMI Non-STEMI
Age (yrs) HR % CI HR % CI
>
Medical history HF MI
TIA/Stroke
Hospital complications
Cardiogenic shock HF
Stroke
Goldberg RJ et al.Am J Cardiol 2004;93:

75. Factors Associated with an Increased Risk of Post-Discharge
Death in Patients with UA
Characteristic
Age (yrs) HR % CI
Medical history HF MI
PCI
Hospital complications
Cardiogenic shock HF
Goldberg RJ et al.Am J Cardiol 2004;93:

76. From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes: The Global Registry of Acute Coronary Events (GRACE)
Keith A.A. Fox, Shaun G. Goodman, Frederick A. Anderson Jr., Christopher B.Granger, Mauro Moscucci, Marcus D. Flather , Frederick Spencer, Andrzej Budaj, Omar H. Dabbous, Joel M. Gore on behalf of the GRACE Investigators
European Heart Journal 2003;24:

77. Temporal Trends in ACS Diagnostic Categories

78. Temporal Trends STEMI: In-hospital Therapies
*without PCI
Fox KAA et al. Eur Heart J 2003;24:

79. Temporal Trends STEMI: Reperfusion
*within 12 h
Fox KAA et al. Eur Heart J 2003;24:

80. Temporal Trends NSTEMI: In-hospital Therapies
Fox KAA et al. Eur Heart J 2003;24:

81. GRACE Palm Pilot Software In-hospital, 6-months Death, Death/MI Prediction Model

83. GRACE PDA Software

84. GRACE PDA Software

85. At Admission Risk Model

86. At Discharge Risk Model

87. GRACE Publications

88. Abstract Acceptance Rate (1999 to 2007)
Number of abstracts accepted = 111

89. Manuscript Status

90. GRACE Quarterly Reports to Investigators

91. Quarterly Report Current Quarter vs. Overall

92. Quarterly Report Temporal Trends

93. Unique Features of GRACE
Multi-national perspective
Full spectrum of coronary syndromes
Increased data on demographics, presentation, management and outcome
Regular audits of data quality
Feedback to participating sites
6-month follow-up