Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry

• Published in: European heart journal 2009-10, Vol.30 (19), p.2318-2326
• Main Authors: Alberts, Mark J., Bhatt, Deepak L., Mas, Jean-Louis, Ohman, E. Magnus, Hirsch, Alan T., Röther, Joachim, Salette, Geneviève, Goto, Shinya, Smith, Sidney C., Liau, Chiau-Suong, Wilson, Peter W.F., Steg, Ph. Gabriel
• Format: Article
• Language: English
• Subjects: Aged; Ambulatory Care - standards; Anticoagulants - therapeutic use; Antihypertensive Agents - therapeutic use; Atherothrombosis; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cerebrovascular disease; Coronary artery disease; Coronary Artery Disease - prevention & control; Coronary heart disease; Diabetes Complications - complications; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Esc Barcelona Fasttrack; Female; Follow-Up Studies; Heart; Hospitalization - statistics & numerical data; Humans; Hypertension - complications; Hypoglycemic Agents - therapeutic use; Male; Medical sciences; Myocardial Infarction - etiology; Neurology; Obesity - complications; Peripheral arterial disease; Peripheral Vascular Diseases - etiology; Registries; Risk Factors; Secondary Prevention; Smoking - adverse effects; Stroke - etiology; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehp355

Aims To determine 3-year event rates in outpatients with vascular disease enrolled in the REduction of Atherothrombosis for Continued Health (REACH) Registry. Methods and results REACH enrolled 67 888 outpatients with atherothrombosis [established coronary artery disease (CAD), cerebrovascular disease, or peripheral arterial disease (PAD)], or with at least three atherothrombotic risk factors, from 44 countries. Among the 55 499 patients at baseline with symptomatic disease, 39 675 were eligible for 3-year follow-up, and 32 247 had data available (81% retention rate). Among the symptomatic patients at 3 years, 92% were taking an antithrombotic agent, 91% an antihypertensive, and 76% were on lipid-lowering therapy. For myocardial infarction (MI)/stroke/vascular death, 1- and 3-year event rates for all patients were 4.2 and 11.0%, respectively. Event rates (MI/stroke/vascular death) were significantly higher for patients with symptomatic disease vs. those with risk factors only at 1 year (4.7 vs. 2.3%, P < 0.001) and at 3 years (12.0 vs. 6.0%, P < 0.001). One and 3-year rates of MI/stroke/vascular death/rehospitalization were 14.4 and 28.4%, respectively, for patients with symptomatic disease. Rehospitalization for a vascular event other than MI/stroke/vascular death was common at 3 years (19.0% overall; 33.6% for PAD; 23.0% for CAD). For patients with symptomatic vascular disease in one vascular bed vs. multiple vascular beds, 3-year event rates for MI/stroke/vascular death/rehospitalization were 25.5 vs. 40.5% (P < 0.001). Conclusion Despite contemporary therapy, outpatients with symptomatic atherothrombotic vascular disease experience high rates of recurrent vascular events and rehospitalizations.