LAUSR

This Focus Issue on Acute Cardiovascular Care contains the Special Article entitled ‘Data standards for acute coronary syndrome and percutaneous coronary intervention: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart)’ by Gorav Batra from Uppsala University in Sweden, and colleagues. Standardized data definitions are essential for monitoring and benchmarking the quality of care and patient outcomes in observational studies and randomized controlled trials. There are no contemporary pan-European data standards for acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology (ESC) aimed to develop such data standards for ACS and PCI. Following a systematic review of the literature on ACS and PCI data standards and evaluation of contemporary ACS and PCI registries, we undertook a modified Delphi process involving clinical and registry experts from 11 European countries, as well as representatives from relevant ESC Associations, including the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Acute CardioVascular Care (ACVC). This resulted in final sets of 68 and 84 ‘mandatory’ variables and several catalogues of optional variables for ACS and PCI, respectively. Data definitions were provided for these variables, which have been programmed as the basis for continuous registration of individual patient data in the online EuroHeart IT platform. By means of a structured process and the interaction with major stakeholders, internationally harmonized data standards for ACS and PCI have been developed. In the context of the EuroHeart project, this will facilitate country-level quality of care improvement, international observational research, registry-based randomized trials, and post-marketing surveillance of devices and pharmacotherapies. Cardiac biomarkers have a strong value for diagnosis and monitoring of major cardiac diseases with the examples of high-sensitivity cardiac troponin I and high-sensitivity cardiac troponin T for ACS and B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for heart failure. In a Viewpoint article entitled ‘Interferences with cardiac biomarker assays: understanding the clinical impact’, Arnaud Nevraumont from the Cliniques universitaires Saint-Luc and Université catholique de Louvain in Brussels, Belgium, and colleagues note that their main weakness remains the susceptibility to analytical interferences. Indeed, each of these tests can be impaired by interferences leading to incorrect results with potentially lifethreatening consequences. The optimization of assays as well as the continuous education and communication between clinical laboratories and physicians remain key factors to limit the real threat of analytical interferences. The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with ACS with or without ST-segment elevation. In a Clinical Research article entitled ‘Ethnicity-dependent performance of the Global Registry of Acute Coronary Events risk score for prediction of non-ST-segment elevation myocardial infarction in-hospital mortality: nationwide cohort study’, Saadiq Moledina from Keele University in Stoke-on-Trent, UK, and colleagues indicate that little is known about its performance at predicting in-hospital mortality for ethnic minority patients. The authors identified 326 160 admissions with non-ST-segment elevation myocardial infarction (NSTEMI) in the Myocardial Infarction National Audit Project (MINAP), 2010–17, including White (n= 299 184) and ethnic minorities (excludingWhite minorities) (n= 26 976). They calculated the GRACE score for in-hospital mortality and assessed ethnic