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| Global Registry of Acute Coronary Events | |
|---|---|
| Name | Global Registry of Acute Coronary Events |
| Formation | 1999 |
| Type | Clinical registry |
| Headquarters | International |
| Region served | Worldwide |
Global Registry of Acute Coronary Events The Global Registry of Acute Coronary Events (GRACE) is an international clinical registry and research consortium that collected patient-level data on myocardial infarction, unstable angina, and related acute coronary syndrome presentations to improve outcomes and inform guideline development. GRACE linked observational data from emergency departments, cardiology wards, and intensive care units to analyses led by academic investigators from institutions such as McMaster University, University of Glasgow, Imperial College London, University of Edinburgh, and University of Toronto. The registry produced risk models, quality indicators, and outcome benchmarks that influenced practice across health systems in United States, United Kingdom, Canada, Australia, Germany, and other countries.
GRACE operated as a collaborative network of hospitals and investigators including centers associated with St. Michael's Hospital (Toronto), Royal Infirmary of Edinburgh, St George's, University of London, Charité – Universitätsmedizin Berlin, and Royal Melbourne Hospital. The registry pooled anonymized data on demographics, clinical presentation, management strategies, biomarkers such as troponin I and creatine kinase MB, procedural details for percutaneous coronary intervention and coronary artery bypass grafting, and outcomes including mortality, reinfarction, and rehospitalization. GRACE generated influential tools like the GRACE Risk Score that were compared with other prognostic instruments developed at TIMI Study Group, PURSUIT trial group, FRAMINGHAM Heart Study, and SALTIRE trial–related analyses.
GRACE was initiated in 1999 by investigators linked to academic centers and cardiology societies including the European Society of Cardiology, American College of Cardiology, Canadian Cardiovascular Society, and national bodies in multiple countries. Early collaborators included researchers from McMaster University Medical Centre, University of Glasgow Medical School, and Royal Brompton Hospital. The registry expanded through partnerships with regional initiatives such as Swedish Coronary Angiography and Angioplasty Registry, Singapore Myocardial Infarction Registry, and national audits like the Myocardial Ischaemia National Audit Project. GRACE's governance involved steering committees with members from World Health Organization–affiliated working groups and independent academic statisticians from Johns Hopkins University, Harvard Medical School, and University College London.
GRACE used prospective, observational cohort methods enrolling consecutive patients presenting with suspected acute coronary syndromes to participating centers. Data collection followed standardized case report forms and definitions aligned with consensus statements from European Society of Cardiology and American Heart Association. Variables included clinical signs, electrocardiogram findings, biochemical markers including B-type natriuretic peptide in selected substudies, reperfusion times, medication use such as aspirin, clopidogrel, beta blockers, and procedural timing for primary percutaneous coronary intervention. Statistical analyses used multivariable modeling, survival analysis, and validation against external cohorts from TIMI, CRUSADE, and ACTION Registry–GWTG. The GRACE Risk Score underwent recalibration and validation in datasets from Japan, Brazil, France, Italy, and Spain.
GRACE documented international variation in presentation, management, and outcomes, revealing gaps in timely reperfusion and secondary prevention across centers including those in United States, India, China, and South Africa. The registry demonstrated relationships between delays to reperfusion therapy and mortality comparable to observations from the SHOCK trial and analyses by GUSTO investigators. GRACE-derived risk stratification tools outperformed or complemented other models from TIMI Risk Score for STEMI and provided prognostic estimates for in-hospital and 6-month mortality used in studies by European Cardiovascular Research Institute and national audit programs. Publications from GRACE influenced comparative effectiveness research at institutions such as Mayo Clinic, Cleveland Clinic, and Karolinska Institutet.
Guideline committees at European Society of Cardiology, American College of Cardiology, American Heart Association, and national societies incorporated GRACE evidence into recommendations on risk stratification, timing of invasive strategies, and antiplatelet therapy selection. Quality improvement programs such as Get With The Guidelines referenced GRACE benchmarks while national audits like the Myocardial Ischaemia National Audit Project used GRACE-derived metrics to monitor performance. Health technology assessments at agencies including National Institute for Health and Care Excellence and Agency for Healthcare Research and Quality cited GRACE findings when evaluating systems of care, reperfusion strategies, and resource allocation.
GRACE included sites across continents, with notable participation from centers in Europe (United Kingdom, Germany, France, Spain, Italy), North America (United States, Canada), Asia (Japan, China, India, Singapore), Australia, Brazil, and South Africa. Collaborations extended to registries and consortia such as EuroHeart, ISAR-REACT trial network, ACCORD Trial, and national cardiovascular audit programs. Academic partners included McMaster University, Imperial College London, University of Toronto, Johns Hopkins University, and Karolinska Institutet, while policy engagement involved World Health Organization consultants and national ministries of health.
Critiques of GRACE cited observational design limitations similar to those raised about other registries like CRUSADE and NCDR: potential selection bias, variable data quality across centers including high-volume referral hospitals such as Cleveland Clinic versus smaller community hospitals, and limited granularity on socioeconomic determinants used in analyses by Framingham Heart Study investigators. Temporal heterogeneity, evolving biomarker assays (e.g., transition to high-sensitivity troponin tests), and changing pharmacotherapy (newer antiplatelet agents from Bristol-Myers Squibb and Sanofi portfolios) challenged longitudinal comparisons. Some guideline panels noted that randomized trials such as PLATO and TRITON–TIMI 38 provided complementary causal evidence where registry associations could not establish causality.
Category:Cardiology registries