The GREECS (GREEk acute Coronary Syndrome) is a prospective cohort study that established in 2003 at the Cardiology clinics of six General Hospitals of NHS in Greece. The baseline examination was performed between October 1, 2003 and September 30, 2004, during which 2,172 consecutive cardiac patients that entered in the Cardiology Clinics or the emergency units of six major General Hospitals, in Greece (Hippokration hospital in Athens, and the general hospitals in Lamia, Karditsa, Halkida, Kalamata and Zakynthos island) (participation rate = 98%). By the exception of Athens - where there are several other hospitals -, all the other hospitals cover the whole population of the aforementioned regions, including urban and rural areas. The studied regions were randomly selected from all Greek regions in order to cover a wide range of the county. Study's supervisor(s) : Prof Demosthenes Panagiotakos, Prof Christos Pitsavos, and the Chief Cardiology Dept(s) Dr Antonoulas, Dr Zombolos, Dr Kogias, Dr Mantas, Dr Stravopodis.
Goals of the Study
The Study aimed to evaluate the role of various CVD related risk factors on the Acute Coronary Syndrome (ACS) development and prognosis among cardiac patients.
Detailed information about the study aims, design, sampling procedure, and methodology can be found in previously published papers.
Sample
During October 2003 - September 2004, n=2172 consecutive patients with discharge diagnosis of ACS (i.e., acute myocardial infarction (AMI) or unstable angina (UA)) that were hospitalized in the cardiology clinics or the emergency units of six major General Hospitals in Greece (i.e. Hippokration hospital in Athens and the general prefectural hospitals in Lamia, Karditsa, Halkida, Kalamata and Zakynthos island) were enrolled into the study (participation rate varied from 80% to 95%) (1649 men, 65±13 years old and 523 women, 72±11 years old, p<0.001).
The hospitals were selected in order to represent populations with various socio-economic, cultural and regional characteristics. By the exception of the metropolitan city of Athens - where there are several other hospitals -, all the other hospitals cover the whole population of the aforementioned regions, including urban and rural areas.
Ethics
The study was approved by the Medical Research Ethics Committee of the participated Institutions and was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association.
Follow-up evaluation
During the 10-year (2004-14) follow-up, of the n=2172 initially enrolled patients, n=1,918 were found (88% participation rate). The rest n=254 (11.7%) of the patients that were lost in the 10-year follow-up were considered as censored. In 2024 the 20-year follow-up was performed. Follow-up examinations included information on the development and management of hypercholesterolemia, hypertriglyceridemia, hypertension, and diabetes mellitus, the onset of non-fatal and fatal CVD event (i.e., myocardial infarction, angina pectoris, other identified forms of ischemia; coronary revascularization (i.e., coronary artery bypass surgery and percutaneous coronary intervention), heart failure of different types, and chronic arrhythmias; ischaemic stroke, or transient ischaemic attack), as well as participants' vital status (death from any cause), according to the 10th WHO International Coding of Disease classification (ICD-10). Physicians of the study confirmed the clinical diagnosis of the patients after assessing their medical records.
Publications
The findings from the GREECS study have been reported in 30+ peer-reviewed publications in 30+ International scientific journals; a detailed list may be found here. Study's publications achieved 5.000+ citations; h-index 17 (2023) | 500+ presentations in national and International Conferences (including ESC, ACC, AHA, IAS, EAS).
Impact of the Study
2.172 ACS patients | 2 follow-up examinations (2014, 2024) | 29.345 person-years of observation | 425 factors measured | 5 PhD thesis | 50+ interviews in Media around the world.