acute coronary syndrome ( acs ) represents one of the most common causes of death worldwide . several practice guidelines have been developed in europe and north america to improve outcome of acs patients through implementation of the recommendations into clinical practice . it is well know that there is wide gap between guidelines and implementation in real practice as was demonstrated in registry findings mainly conducted in the developed world . a prospective observational acute coronary syndrome ( renasica ii ) registry conducted by the mexican cardiology society from december 2002 to november 2003 . the main objective was to provide insights into risk factors and clinical characteristics , use of diagnostic resources , risk stratification , acute treatments , and hospital outcomes in patients hospitalized with acs . patients were enrolled at 60 hospitals ( 48% public health system hospitals , 39% private hospitals , and 12% teaching hospitals from other health systems ) . almost half ( 48% ) of the hospitals were enrolled in mexico city . tertiary - care hospitals ( 35% ) with access to coronary angiography , percutaneous coronary angioplasty and coronary artery bypass grafting ( cabg ) enrolled 90% of the patients . patients with characteristics of stemi on electrocardiogram ( ecg ) and who presented within 24 hours from symptoms ' onset were eligible for enrollment . the diagnosis of stemi was confirmed by the presence of biomarkers of myocardial necrosis and characteristic evolving changes on the ecg . in - hospital outcome was analyzed through major adverse cardiac events , including death , recurrent ischemia , acute mi , re - infarction , shock and stroke . 502 patients were excluded due to unspecified chest pain . of the remaining 8098 patients , 4555 ( 56.3% ) the most prevalent risk factors were smoking ( 66% ) , hypertension ( htn ) ( 50% ) , diabetes mellitus ( dm ) ( 43% ) , and hypercholesterolemia ( 26% ) . a history of previous mi was present in 23% . on admission 85% of patients had typical chest pain and 74% of patients presented with killip class i. anterior mi occurred in 56% of patients and postero - inferior mi in 40% of patients . 88% of patients received aspirin during acute hospitalization , 64% angiotensin - converting enzyme inhibitors and 51% -blockers . only 37% of patients received fibrinolytic therapy , where streptokinase was the most frequent fibrinolytic regimen used and 15% had primary pci performed . major adverse cardiac conditions were as follows ; recurrent ischemic in 12% , re - infarction in 4% , cardiogenic shock in 4% , and stroke in 1% . , killip class iv , high - grade av block , inferior st elevation , left bundle branch block ( lbbb ) , cardiogenic shock , stroke and re - infarction . the renasica ii was the largest acs registry in latin america and provided important insights into risk factors , management and outcome in that part of the world . the investigators compared their findings with previously published registries , most importantly registries from high - income countries , such as the global registry of acute cardiac events ( grace ) , the national registry of myocardial infarction ( nrmi ) , and the euro heart survey ( ehs ) 1 and 2 . dm and smoking were overrepresented in mexican patients whereas high total cholesterol and triglycerides had a lower frequency when compared with high - income populations . the proportion of stemi cases among acs patients , the frequencies of hypertension , male sex and 30-day death rates were comparable with those registries . lytic therapy was the most frequently reperfusion therapy and the vast majority of patients ( 82% ) were treated with streptokinase because of its wider availability and lower cost than other fibrinolytic agents . ischemic time delay in renasica ii was attributed to the limitations and barriers that exist in limcs for a timely first medical contact and decreasing the door - to - reperfusion period and was similar to that reported in the create ( treatment and outcomes of acute coronary syndromes in india ) and access registries . the investigators reported several limitations of their study including ; relatively old registry ( 20022003 ) and most patients were recruited in hospitals with coronary care units from the mexico city . we compared the findings of renasica ii to that of registries recently conducted in the middle east ; gulf race ( registry of acute cardiac events ) and gulf race ii ( see table 1 ) . it is noteworthy that the prevalence of dm among acs in both regions ( 40% ) is probably the highest when compared to other ethnicities ( 2235% ) . we also reported high prevalence of metabolic syndrome ( 46% ) , data on metabolic syndrome was lacking in renasica ii . mexican acs patients were older and had higher prevalence of htn , smoking when compared to their middle - eastern counterparts . furthermore , mexicans were more likely to present stemi , while ppci percentage use was very low in both regions when compared to reports from registries conducted in europe and north america . findings from gulf race and gulf race-2 resulted in changing practice for stemi patients in qatar . countrywide primary ppci ( 24 hours service ) in qatar , which was launched in october 2013 and so far it is the main modality of reperfusion therapy ( > 99% of stemi patients ) , further highlighting the importance of conducting regional registries for quality improvement . renasica ii highlights the importance of conducting registries in various geographic locations and among different ethnicities . these registries represent a link between randomized clinical trials , guidelines , and real clinical practice in the various communities and may help decision makers for quality improvement in the care of stemi patients .