Several coronary heart disease registries have gathered data on specific aspects of heart disease, but none has looked at the spectrum of acute coronary syndromes. Since June 1999, the Global Registry of Acute Coronary Events (GRACE) has been collecting clinical data on patients with unstable angina, non-ST-elevation myocardial infarction and ST-elevation myocardial infarction. GRACE gathers data from 94 hospitals in 14 countries on current practices of care provided to patients with acute coronary syndromes. This report reviews the origins, values and limitations of disease registries; summarizes the objectives of GRACE; and presents preliminary data obtained in the first 13,000-plus patients enrolled in the registry.