The Global Registry of Acute Coronary Events (GRACE) is an international observational registry collecting data on the characteristics, management and outcomes of patients with acute coronary syndromes (ACS), including myocardial infarction (ST-segment elevation myocardial infarction [STEMI] and non-STEMI) and unstable angina. The aim of GRACE is to narrow the gap between evidence and clinical practice, by providing clinicians with a useable, reliable risk-prediction tool and quarterly reports containing regional and international data on the full spectrum of patients with ACS.


Data from all non-transfer patients presenting between 1999 and 2006 to GRACE hospitals with new or presumed ST-elevation myocardial infarction (STEMI) and/or left bundle branch block (LBBB) within 12 h of symptom onset, were analysed (n=10,954 patients). In particular, demographic factors, comorbid conditions, timing and type of reperfusion treatment, and in-hospital and 6-month outcomes were reported.

Between April 1999 and June 2006, there was an increasing trend in the use of primary percutaneous coronary intervention (PPCI) from 15% to 44% (p <0.001), while use of thrombolytic therapy decreased (from 41% to 16%; p <0.01). These findings mirror results from the NRMI registry in the United States.

The median time to fibrinolysis was reduced from 40 min in 1999 to 34 min in 2006 (p <0.001), but the delay to PPCI remained unchanged.

In 2006, 33% of patients still did not receive reperfusion therapy (although this was an improvement on the 40% reported in 1999).

Change in use of reperfusion therapy from 1999 to 2006

Change  in  use  of  reperfusion  therapy  from  1999  to  2006   Bar graph depicting increase in the use of primary percutaneous coronary intervention as reperfusion therapy over thrombolysis over the years from 1999 to 2006

GRACE data was also used to derive the GRACE risk score, for predicting in-hospital and 6-month death and death or MI due to ACS (MI). The GRACE risk score is now endorsed in guidelines produced by the European Society of Cardiology (ESC), the American College of Cardiologists and the American Heart Association (ACC/AHA) and the National Institute for Health and Clinical Excellence (NICE) in the UK. For further information, or to download the risk calculator, visit:

  • GRACE is the largest international observational registry to include data from the complete spectrum of ACS patients to date.
  • The GRACE risk score calculator is recommended in international guidelines.
  • The global effort to improve reperfusion therapy for acute MI is having an impact; nevertheless there are still substantial opportunities for improvement.
  1. Eagle KA, et al. Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 2008;29:609-617.
  2. Fox KA, et al. The Global Registry of Acute Coronary Events, 1999 to 2009 - GRACE. Heart 2010;96:1095-1101.