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Cited by 599Acute Myocardial Infarction ResearchCoronary Interventions and DiagnosticsAntiplatelet Therapy and Cardiovascular Diseases

Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE)

Fox, K·2002·European Heart Journal
DOI 10.1053/euhj.2001.3081
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Abstract

AIMS: Despite advances in the treatment of acute coronary syndromes based on randomized trial data and published guidelines, the extent to which such treatments are applied in practice remains uncertain. Data from clinical trials derive from selected geographical areas and in highly selected populations of patients, and hence may not reflect the overall population. The aim of the study was to investigate variations in hospital management and outcome using unselected data collected in the prospective Global Registry of Acute Coronary Events (GRACE). METHODS AND RESULTS: The 95 hospitals in GRACE were organized into 18 population-based clusters in 14 countries. Information was recorded about patient management and outcome during hospitalization and after discharge. Data on treatments administered were analysed by baseline condition, hospital type, by the presence or absence of a catheterization laboratory, and by geographical region. Of 11543 patients, 44% had an admission diagnosis of unstable angina, 36% presented with myocardial infarction, 9% were admitted to rule out a myocardial infarction, 7% had chest pain and 4% were hospitalized for 'other cardiac' and 'non-cardiac' diagnoses. Of the total GRACE population 38% had a final diagnosis of unstable angina, 30% ST-segment elevation myocardial infarction, 25% non-ST-segment elevation myocardial infarction, and 7% of 'other cardiac' and 'non-cardiac' final diagnoses. The event rates for hospital death or reinfarction were six and 2% for non-ST-segment elevation myocardial infarction, seven and 3% for ST-segment elevation myocardial infarction, and 3% hospital death for unstable angina. The use of aspirin was similar across all hospital types and geographical regions. In contrast, the use of percutaneous coronary intervention and glycoprotein IIb/IIIa inhibitors was higher (P<0.0001) in teaching hospitals and hospitals with catheterization laboratories and was also higher in the United States. At discharge a higher percentage (P<0.0001) of patients received angiotensin-converting enzyme inhibitors in hospitals without catheterization laboratories. The use of statins was lower in non-teaching hospitals and in centres without a catheterization laboratory. CONCLUSIONS: The GRACE study reveals substantial differences in the management of patients based on hospital type and geographical location. Further analyses will determine whether such variations translate into differences in longer term outcomes. GRACE provides a multinational reference for the implementation of therapies of proven efficacy.

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  • Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events.

    “Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events.”

    From Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome (2018) · cites this paper as [1]

    The Results section (p. 1181) reports in-hospital reinfarction after acute coronary syndrome, supporting a risk of recurrent events during admission. The paper says six-month outcomes were collected (Data collection), but it does not report those results here, so it does not establish a high risk of recurrent events after discharge. (LLM, conf=0.80)

    Experimental — accuracy not yet measured

  • The risk of future MACEs and death remains high among patients with acute coronary syndrome despite evidence-based secondary prevention measures including statins and dual antiplatelet therapy.

    “The risk of future MACEs and death also remains high among patients with an acute coronary syndrome (ACS), despite application of evidence-based secondary prevention measures including statins and dual antiplatelet therapy (4).”

    From Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome (2019) · cites this paper as [4]

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Research works printed but not linked: 2

  1. [12]12. Fox KAA, Goodman S, Bigonzi F, Le Louer V, Cohen M and The ESSENCE Trial Investigators. Inter-regional differences and outcome in unstable angina. Eur Heart J 2000; 21: 1433-9.
  2. [18]18. Akkerhuis KM, Deckers JW, Boersma E et al. for the PURSUIT Investigators. Geographic variability in outcomes within an international trial of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes. Eur Heart J 2000; 21: 371-81.

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Authors
Fox, K.
Affiliations
Edinburgh Royal Infirmary (GB)
Corresponding author
Fox, K
ORCID
Fox, K
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2002-08-01
Volume
23
Issue
15
Pages
1177-1189
ISSN
0195-668X (ISSN-L)
DOI
10.1053/euhj.2001.3081
OpenAlex
W2100410292
Semantic Scholar
3a84be7c5ede8fa4444227b36766649ae51e872f
Cited by
599
References
30
Citations by year
2026: 6 · 2025: 6 · 2024: 7 · 2023: 25 · 2022: 18 · 2021: 15 · 2020: 15 · 2019: 15 · 2018: 20 · 2017: 23 · 2016: 23 · 2015: 27 · 2014: 38 · 2013: 25 · 2012: 33
FWCI
22.49
Type
journal article
Language
en
Open access
closed
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship@UMassChan (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Keywords
acute coronary syndrome, clinical practice variation, hospital management, Global Registry of Acute Coronary Events, percutaneous coronary intervention, glycoprotein IIb/IIIa inhibitors, catheterization laboratory, teaching hospitals, aspirin, statins, ACE inhibitors, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina, hospital discharge
MeSH terms
Acute Disease, Aged, Angina, Unstable, Aspirin, Australia, Canada, Europe, Female, Fibrinolytic Agents, Heart Diseases, Humans, Male, Middle Aged, Myocardial Infarction, New Zealand, North America, Registries, South America, Angioplasty, Balloon, Coronary, Treatment Outcome

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