Lessons from ProACS: It's time for the phoenix to rise from the ashes

Registries are of crucial importance to unravel the natural history of diseases, identify patterns of management and treatment, enable the continuous improvement of quality standards, and help identify prognostic factors.The latter then have to be validated in external cohorts before their widespread acceptance and use.In acute coronary syndromes (ACS), several large-scale registries (some national like the NCDR ACTION Registry-GWTG 1 and SWEDEHEART, 2 and others multinational like the Global Registry of Acute Coronary Events (GRACE) 3 and the Euro Heart Survey on acute coronary syndromes 4 ) have identified important prognostic factors and helped in the development of widely used risk scores.5 However, few Portuguese patients were included in the Euro Heart Survey, calling into question its validity in our population.The study by Almeida et al. published in this issue of the Journal 6 used data on consecutive ST-elevation myocardial infarction (STEMI) patients entered in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 2019 to assess the prognostic value of in-hospital brain natriuretic peptide (BNP) levels in the prediction of