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These people are often recruited from social networks, where the funds can be acquired from an equity download, loan, donation, or ordering. The main objective will be to identify outcome in tertiary and community hospitals and perform strategies to improve quality of care. The registry is planned to enroll patients from public health and private hospitals. The registry began in November with a planned recruitment during 12 months and 1-year follow-up Figure 1. The protocol has been approved by institutional ethics committees in all participant centers.

As an observational registry, no specific treatments, tests, or procedures will be mandated or withheld from the patients; participants will be free to withdraw from the registry at any time. All patients will sign an informed consent.

Figure 1. Patients admitted to emergency departments, coronary care units, intensive care units, hospital and hemodynamic laboratories with high clinical suspicion and subsequently proven diagnosis will be eligible.

The initial diagnosis will be established by physician in charge based on clinical and electrocardiographic findings in all cases. The structure, data collection and data analysis were based on current quality recommendations for registries. Principal investigators will be selected in community and tertiary hospitals with a geographical distribution covering the entire country Figure 2.

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Figure 2. Objectives Primary: To identify clinical diagnostic and therapeutic characteristics in Mexico. Secondary: a to assess adherence to guidelines for diagnosis and treatment of ACS; b to identify issues and establish health system strategies to improve patient care; c to identify standards of acute and in-hospital patient care in participating centers; d to propose therapeutic approaches according to available resources and technology; e establish accessible risk stratification in ACS through mortality predictive variables observed in RENASICA II.

At discharge objective evidence of ischemia by invasive or noninvasive testing must be proved. Patients with secondary ischemia anemia, pulmonary embolism, myocarditis, and etcetera and type II infarction will not be included.

Quality criteria The following criteria will be used to improve quality data: a standardized definitions, data and reports; b tools for immediate feedback; c meetings among the scientific and executive committee; d ethics procedures review; e electronic, simple and accessible data collection; f randomized centers selection; g consecutive patients enrollment to obtain representative sample; h random centers audit; i centralized data and statistical analysis; j report all data and consistent conclusion; and k transparency of funds for any publication.

The standardized definitions can be explored in Appendix A. All patients will have a unique personal identification to ensure their anonymity. A simple format to facilitate data entry using the most relevant variables of previous registries will be used.