Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up

GRACE Investigators, Sami M A Alnasser, Wei Huang, Joel M Gore, Ph Gabriel Steg, Kim A Eagle, Frederick A Anderson, Keith A A Fox, Enrique Gurfinkel, David Brieger, Werner Klein, Frans van de Werf, Álvaro Avezum, Gilles Montalescot, Dietrich C Gulba, Andrzej Budaj, Jose Lopez-Sendon, Christopher B Granger, Brian M Kennelly, Robert J GoldbergEmily Fleming, Shaun G Goodman

Research output: Contribution to journalArticlepeer-review


PURPOSE: Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality.

METHODS: Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites.

RESULTS: From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), beta-blocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re)infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80).

CONCLUSION: In this large multinational cohort of acute coronary syndrome patients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained.

Original languageEnglish
Pages (from-to)766-75
Number of pages10
JournalAmerican Journal of Medicine
Issue number7
Publication statusPublished - Jul 2015


  • Acute Coronary Syndrome
  • Age Distribution
  • Aged
  • Angioplasty, Balloon, Coronary
  • Cause of Death
  • Continuity of Patient Care
  • Coronary Artery Bypass
  • Female
  • Follow-Up Studies
  • Global Health
  • Hospital Mortality
  • Humans
  • Internationality
  • Male
  • Middle Aged
  • Patient Discharge
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Survival Analysis
  • Time Factors
  • Treatment Outcome


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