OBJECTIVES: Recently published data from the second Euro Heart Survey on Acute Coronary Syndromes (ACS) provided a broad view of risk factors (RFs) and care pathways, but some large countries contributed few patients to the registry. This study was performed as a complementary analysis to describe RFs in ACS patients undergoing percutaneous coronary intervention (PCI) in 5 large European countries. METHODS: This was a retrospective study using the IMS Health Acute Cardiovascular Analyzer. This is a physician-reported registry in Germany, France, Italy, Spain, and the UK. Data collection timeframe was January - November 2005. Use of PCI and 7 RFs associated with poor outcomes (age was slightly modified from Wallentin, 2005) were described by country. RESULTS: Over 400 cardiologists reported data on 8979 ACS patients. Patient count by country was: Germany-1624, France-1654, Italy-1608, Spain-2039, UK-2054. Including only patients who underwent PCI and received clopidogrel (n=4393), the frequency was lowest in the UK (31.0%) and highest in Germany (68.8%). The index diagnosis was: ST-elevation myocardial infarction (MI) 45%, non ST-elevation MI 29%, unstable angina 26%. Distribution of the 7 RFs was: age >65 ranged from 37.8% (UK) to 48.4% (Spain); males 67.9% (Italy) to 75.9% (France). Diabetes ranged from 25% (France) to 35.4% (Germany). Prior MI ranged from 9.6% (France) to 17.6% (Germany). ST-depression occurred in 21.6% (France) to 47.3% (UK), and elevated troponin occurred in 64.4% (UK) to 80.3% (Spain). Elevated serum creatinine occurred in 4.0% (Italy) to 10.2% (Germany). Mean number of risk factors by country was 2.66-Germany, 2.47-France, 2.62-Italy, 2.8-Spain and 2.68-UK. CONCLUSIONS: This large sample of ACS patients provides additional information on important RFs by country and may be useful to construct country-specific outcomes models. PCI was most frequently used in Germany and the number of RFs was highest in Spain.