Copyright © 2002 by the European Society of Cardiology.
Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE)
a The Royal Infirmary of Edinburgh, Edinburgh, Scotland, U.K.
b Canadian Heart Research Centre and Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
c Klinische Abteilung für Kardidogie, Graz, Austria
d Concord Hospital, Concord, Sydney, Australia
e Hôpital Bichat, Paris, France
f University of Massachusetts Medical School, Worcester, MA, U.S.A.
g CTI-A Hospital Albert Einstein, São Paulo, Brazil
revised October 15, 2001; accepted October 17, 2001
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. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Acute coronary syndromes, unstable angina, myocardial infarction, GRACE, registry, observational studies
f2 Correspondence: Keith A. A. Fox, MB, ChB, FRCP, Department of Cardiology, The Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, Scotland EH3 9YW, U.K.
f1 A complete list of investigators and institutions can be found in Appendix 1.
References
- Am Heart J. 2001;141:190–199[CrossRef][ISI][Medline]
- Fox KAA, Cokkinos DV, Deckers J, Keil U, Maggioni A, Steg G. The ENACT study: a pan-European survey of acute coronary syndromes. Eur Heart J. 2000;21:1440–1449
[Abstract/Free Full Text] - Topol EJ. Targeted approaches to thrombosis inhibition—an end to the shotgun approach. Clin Cardiol. 1997;20:I22–I26
- American Heart Association, 2000 Heart and Stoke Statistical Update
- Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet. 1999;353:154–157[ISI][Medline]
- Akkerhuis KM, Deckers JW, Boersma E. Geographic variability in outcomes within an international trial of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes. Results from PURSUIT. Eur Heart J. 2000;21:371–381
[Abstract/Free Full Text] - Kong DF, Blazing MA, O'Connor CM. Advances in the approach to Acute Coronary Syndromes. Hosp Pract. 2000;35:61–74
- Ryan TJ, Antman EM, Brooks NH. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of acute myocardial infarction). J Am Coll Cardiol. 1999;34:890–911
[Free Full Text] - Braunwald E, Antman EM, Beasley JW. ACC/AHA guidelines for the management of patients with unstable angina and non-ST segment elevation myocardial infarction: Executive summary and Recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of patients with unstable angina). Circulation. 2000;102:1193–1209
[Free Full Text] - Collinson J, Flather MD, Fox KAA. Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation: prospective registry of acute ischemic syndromes in the UK (PRAIS-UK). Eur Heart J. 2000;21:1450–1457
[Abstract/Free Full Text] - Theroux P, Fuster V. Acute coronary syndromes. Circulation. 1998;97:1195–1206
[Free Full Text] - Fox KAA, Goodman S, Bigonzi F, Le Louer V, Cohen M. Inter-regional differences and outcome in unstable angina. Eur Heart J. 2000;21:1433–1439
[Abstract/Free Full Text] - Maynard SJ, Scott GO, Riddell JW, Adgey AAJ. Management of acute coronary syndromes. BMJ. 2000;321:220–223
[Free Full Text] - Alpert JS. Are data from clinical registries of any value? Eur Heart J. 2000;21:1399–1401
[Free Full Text] - Eur Heart J. 1997;18:1569–1582
[Abstract/Free Full Text] - Yusuf S, Flather M, Pogue J. Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation. Lancet. 1998;352:507–514[CrossRef][ISI][Medline]
- O'Shea JC, Califf RM. Inter-regional differences in acute coronary syndrome trials. Eur Heart J. 2000;21:1397–1399
[Free Full Text] - Akkerhuis KM, Deckers JW, Boersma E. Geographic variability in outcomes within an international trial of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes. Eur Heart J. 2000;21:371–381
[Abstract/Free Full Text] - N Engl J Med. 1998;339:436–443
[Abstract/Free Full Text] - Kereiakes DJ, Grines C, Fry E. Enoxaparin and abciximab adjunctive pharmacotherapy during percutaneous coronary intervention. J Invasive Cardiol. 2001;13:272–278[Medline]
- Ferguson JJ. Combining low-molecular-weight heparin and glycoprotein IIb/IIIa antagonists for the treatment of acute coronary syndromes: the NICE 3 story. National Investigators Collaborating on Enoxaparin. J Invasive Cardiol. 2000;12:E10–3
- Eur Heart J. 2001;22:554–572
[Abstract/Free Full Text] - Bertrand ME, Simoons ML, Fox KAA. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation: Recommendations of the task force of the European Society of Cardiology. Eur Heart J. 2000;21:1406–1432
[Free Full Text] - Cohen M, Demers C, Gurfinkel EP. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med. 1997;337:447–452
[Abstract/Free Full Text] - Antman EM, McCabe CH, Gurfinkel EP. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation. 1999;100:1593–1601
[Abstract/Free Full Text] - Rogers WJ, Canto JG, Lambrew CT. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol. 2000;36:2056–2063
[Abstract/Free Full Text] - Rogers WJ, Canto JG, Barron HV, Boscarino JA, Shoultz DA, Every NR. Treatment and outcome of myocardial infarction in hospitals with and without invasive capability. Investigators in the National Registry of Myocardial Infarction. J Am Coll Cardiol. 2000;35:371–379
[Abstract/Free Full Text] - Yusuf S. Design, baseline characteristics, and preliminary clinical results of the Organization to Assess Strategies for Ischemic Syndromes-2 (OASIS-2) trial. Am J Cardiol. 1999;84:20M–25M[ISI][Medline]
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
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|
|
|
|
 |
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 F. A. Spencer, J. Allegrone, R. J. Goldberg, J. M. Gore, K. A.A. Fox, C. B. Granger, R. H. Mehta, D. Brieger, and the GRACE Investigators* Association of Statin Therapy with Outcomes of Acute Coronary Syndromes: The GRACE Study Ann Intern Med, June 1, 2004; 140(11): 857 - 866. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
A. Di Chiara, F. Chiarella, S. Savonitto, D. Lucci, L. Bolognese, S. De Servi, C. Greco, A. Boccanelli, P. Zonzin, S. Coccolini, et al. Epidemiology of acute myocardial infarction in the Italian CCU network: The BLITZ Study Eur. Heart J., September 2, 2003; 24(18): 1616 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Niemela and S. Vikman Early invasive therapy of non ST-elevation acute coronary syndromes -- combined with upstream antiplatelet therapy: yes -- but how early? Eur. Heart J., August 1, 2003; 24(15): 1383 - 1384. [Full Text] [PDF]
|
|
|
|
|
|
K. A.A Fox, S. G Goodman, F. A Anderson Jr., C. B Granger, M. Moscucci, M. D Flather, F. Spencer, A. Budaj, O. H Dabbous, J. M Gore, et al. 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) Eur. Heart J., August 1, 2003; 24(15): 1414 - 1424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Gabriel Steg, B. Iung, L. J Feldman, A. P Maggioni, U. Keil, J. Deckers, D. Cokkinos, K. A.A Fox, and for the ENACT investigators Determinants of use and outcomes of invasive coronary procedures in acute coronary syndromes: results from ENACT Eur. Heart J., April 1, 2003; 24(7): 613 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]
|
|
|
|
|
|
J L Ferguson, G J Beckett, M Stoddart, S W Walker, and K A A Fox Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction Heart, October 1, 2002; 88(4): 343 - 347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.S. Alpert Acute coronary syndromes observed from an international perspective Eur. Heart J., August 1, 2002; 23(15): 1139 - 1140. [Full Text] [PDF]
|
|
|
|
|
|
M.L. Simoons The quality of care in acute coronary syndromes Eur. Heart J., August 1, 2002; 23(15): 1141 - 1142. [Full Text] [PDF]
|
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