Goodman Shaun G, Huang Wei, Yan Andrew T, Budaj Andrzej, Kennelly Brian M, Gore Joel M, Fox Keith A A, Goldberg Robert J, Anderson Frederick A
Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, 30 Bond St, Room 6-034 Queen, Toronto, Ontario M5B 1W8, Canada.
Am Heart J. 2009 Aug;158(2):193-201.e1-5. doi: 10.1016/j.ahj.2009.06.003.
The Global Registry of Acute Coronary Events (GRACE)-a prospective, multinational study of patients hospitalized with acute coronary syndromes (ACSs)-was designed to improve the quality of care for patients with an ACS. Expanded GRACE aims to test the feasibility of a simplified data collection tool and provision of quarterly feedback to index individual hospital management practices to an international reference cohort.
We describe the objectives; study design; study and data management; and the characteristics, management, and hospital outcomes of patients > or =18 years old enrolled with a presumptive diagnosis of ACS.
From 2001 to 2007, 31,982 patients were enrolled at 184 hospitals in 25 countries; 30% were diagnosed with ST-segment elevation myocardial infarction, 31% with non-ST-segment myocardial infarction, 26% with unstable angina, and 12% with another cardiac/noncardiac final diagnosis. The median age was 65 (interquartile range 55-75) years; 24% were >75 years old, and 33% were women. In general, increases were observed over time across the spectrum of ACS (1) in the use in the first 24 hours and at discharge of aspirin, clopidogrel, beta-blockers, and angiotensin-converting enzyme inhibitors/receptor blockers; (2) in the use at discharge of statins; (3) in the early use of glycoprotein IIb/IIIa inhibitors and low-molecular-weight heparin; and (4) in the use of cardiac catheterization and percutaneous coronary intervention. An increase in the use of primary percutaneous coronary intervention and a similar decrease in the use of fibrinolysis in ST-segment elevation myocardial infarction were also seen.
Over the course of 7 years, general increases in the use of evidence-based therapies for ACS patients were observed in the expanded GRACE.
全球急性冠状动脉事件注册研究（GRACE）——一项针对急性冠状动脉综合征（ACS）住院患者的前瞻性、多中心研究——旨在提高ACS患者的治疗质量。扩展版GRACE旨在测试简化数据收集工具及每季度向各医院提供反馈以将其管理实践与国际参考队列进行比对的可行性。
我们描述了研究目的、研究设计、研究及数据管理，以及年龄≥18岁、初步诊断为ACS的患者的特征、治疗及住院结局。
2001年至2007年，25个国家的184家医院纳入了31982例患者；30%被诊断为ST段抬高型心肌梗死，31%为非ST段心肌梗死，26%为不稳定型心绞痛，12%最终诊断为其他心脏/非心脏疾病。中位年龄为65岁（四分位间距55 - 75岁）；24%的患者年龄>75岁，33%为女性。总体而言，随着时间推移，各类ACS患者在以下方面均有增加：（1）阿司匹林、氯吡格雷、β受体阻滞剂及血管紧张素转换酶抑制剂/受体阻滞剂在发病后24小时内及出院时的使用；（2）他汀类药物在出院时的使用；（3）糖蛋白IIb/IIIa抑制剂及低分子量肝素的早期使用；（4）心脏导管插入术及经皮冠状动脉介入治疗的使用。ST段抬高型心肌梗死患者中，直接经皮冠状动脉介入治疗的使用增加，同时纤维蛋白溶解治疗的使用相应减少。
在扩展版GRACE研究的7年期间，观察到ACS患者循证治疗的总体使用有所增加。
