OBJECTIVES: To describe current real-world data on in-hospital/long-term mortality and morbidity outcomes in patients in the western world with acute coronary syndromes (ACS). METHODS: We conducted a review of publications from international registries: GRACE (Global Registry of Acute Coronary Events) and GRACE expanded (both worldwide); GRACE UK-Belgium; and EuroHeart survey II/III (Europe/Mediterranean basin). The most recent data on in-hospital/long-term outcomes were stratified by ACS type: ST-elevation myocardial infarction (STEMI) and non-ST elevation Acute Coronary Syndromes (NSTE ACS), which includes unstable angina (UA) and the non-ST elevation myocardial infarction (NSTEMI). RESULTS: In-hospital mortality rates were 4.6–7.8% in STEMI patients, 2.2–5.9% in NSTEMI patients, and 0.8–2.7% in UA patients. At 6 months post-discharge, mortality rates were 4.5–4.8% in STEMI patients, 6.2% in NSTEMI patients, and 3.6% in patients with UA. These rates increased to 19%, 22%, and 18% in STEMI, NSTEMI, and UA, respectively, at 5 years post-discharge. The most common morbidities were in-hospital congestive heart failure (STEMI, 11–15%; NSTEMI, 6.1–10%; and UA, 6%) and in-hospital myocardial (re)infarction (STEMI, 2–2.8%; and NSTE-ACS, 1.7–2.4%). Six months post-discharge myocardial (re)infarction rates were 2% in STEMI patients and 2.9% in NSTE-ACS patients, which are lower than previously reported in clinical trials.  CONCLUSIONS: Despite current treatments, a substantial proportion of patients with ACS still suffer death and serious morbidities in the acute phase of the disease and longer term. Further research is needed to improve acute and long-term therapies.