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European Heart Journal Advance Access published online on November 7, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn478
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. 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

Modifiable risk factors control and its relationship with 1 year outcomes after coronary artery bypass surgery: insights from the REACH registry

Rajendra H. Mehta1,2,*, Deepak L. Bhatt3, Ph. Gabriel Steg4, Shinya Goto5, Alan T. Hirsch6, Chiau-Suong Liau7, Joachim Röther8, Peter W.F. Wilson9, Alain-Jean Richard10, Kim A. Eagle11, E. Magnus Ohman1,2 on behalf of the REACH Registry Investigators

1 Duke Clinical Research Institute, 2400 Pratt Street, PO Box 17969, Durham, NC, USA
2 Duke University Medical Center, Durham, NC, USA
3 VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, MA, USA
4 INSERM U-698 Université Paris VII, APHP, Paris, France
5 Tokai University School of Medicine, Isehara, Japan
6 University of Minnesota School of Public Health, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
7 National Taiwan University Hospital, School of Medicine, Taipei, Taiwan
8 Klinikum Minden, Minden, Germany
9 Emory University School of Medicine, GA, USA
10 Sanofi-Aventis Group, Paris, France
11 University of Michigan, MI, USA

Received 18 February 2008; revised 27 September 2008; accepted 9 October 2008.

* Corresponding author. Durham, NC 27715. Tel: +1 919 668 8971, Fax: +1 919 668 7059, Email: mehta007{at}dcri.duke.edu

Aims: To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG).

Methods and results: Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline <25, 25–<50, 50–<75, and ≥75% risk factors were at goal in 3.7, 12.9, 31.7, and 51.7% of patients, respectively. One-year composite rates of CV death, non-fatal MI, non-fatal stroke were inversely related to the proportion of risk factors at goal at baseline (age, gender, and region adjusted rates 6.1, 5.6, 5.2, and 4.3% of patients with <25, 25–<50, 50–<75, and >75% risk factors at goal, respectively; P for trend 0.059).

Conclusion: Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health.

Key Words: Coronary disease • Bypass • Revascularization • Stroke • Risk factors


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