Introduction and Methods - In 2006, the French registries in Strasbourg, Toulouse, and Lille expanded their systematic protocol for identifying cases of myocardial infarction and coronary deaths in the population aged 35 to 74 to include all episodes of acute coronary syndrome (ACS). Results - The inclusion of cases of coronary syndrome, unstable angina, and other acute forms of coronary artery disease diagnosed by clinicians increased the total number of episodes studied by 60%. Trends in attack and incidence rates by age and sex were similar for most categories, but their distribution across centers differed. This indication of a variable clinical presentation of the disease across regions was reinforced by the observation of lower short-term survival (28 days) for ACIs in Lille compared to Toulouse, with Strasbourg showing intermediate survival rates. Conclusions - The expansion of registry-based recording of ACS episodes beyond myocardial infarction and coronary death has provided a more comprehensive view of the distribution of the disease in the population, particularly at the regional level. (R.A.)