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European Heart Journal Advance Access originally published online on August 31, 2009
European Heart Journal
2009 30(19):2318-2326; doi:10.1093/eurheartj/ehp355
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

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

Mark J. Alberts1,*, Deepak L. Bhatt2, Jean-Louis Mas3, E. Magnus Ohman4, Alan T. Hirsch5, Joachim Röther6, Geneviève Salette7, Shinya Goto8, Sidney C. Smith, Jr9, Chiau-Suong Liau10, Peter W.F. Wilson11, Ph. Gabriel Steg12 and for the REduction of Atherothrombosis for Continued Health (REACH) Registry Investigators{dagger}

1 Department of Neurology, Northwestern University Medical School, 710 N Lake Shore Drive, Room 1420, Chicago, IL 60611, USA
2 VA Boston Healthcare System and Brigham and Women's Hospital, Boston, MA, USA
3 Department of Neurology, Hôpital Sainte-Anne, Paris-Descartes University, INSERM U894, Paris, France
4 Division of Cardiology, Duke University, Durham, NC, USA
5 Minneapolis Heart Institute Foundation, and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
6 Department of Neurology, Academic Teaching Hospital Hannover Medical School, Johannes Wesling Klinikum, Minden, Germany
7 sanofi-aventis, Paris, France
8 Tokai University School of Medicine, Isehara, Japan
9 Center for Cardiovascular Science and Medicine, University of North Carolina, NC, USA
10 National Taiwan University Hospital, Taipei, Taiwan
11 Atlanta VA Medical Center and Emory University School of Medicine, Atlanta, GA, USA
12 INSERM U-698, Université Paris 7, AP-HP, Paris, France

Received 31 July 2009; revised 10 August 2009; accepted 12 August 2009; online publish-ahead-of-print 31 August 2009.

* Corresponding author. Tel: +1 312908 5095, Fax: +1 3125033593, Email: m-alberts{at}northwestern.edu

See page 2297 for the commentary on this article (doi:10.1093/eurheartj/ehp356)

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.

Key Words: Atherothrombosis • Risk factors • Coronary artery disease • Cerebrovascular disease • Peripheral arterial disease

{dagger} A complete list of the REACH Registry Investigators appears in JAMA 2006;295:180–189.


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