List of Authors:
Mark J Alberts, Ph Gabriel Steg, Deepak L Bhatt, Jean-Louis Mas, E Magnus Ohman, Alan T Hirsch, Joachim Röther
Abstract:
Background:
Atherothrombotic vascular disease is the leading cause of morbidity and mortality throughout the world. Accurate, contemporary and international data on the outcomes of outpatients with vascular disease are important for planning medical interventions and formulating effective public health policies, but are lacking.
Methods:
We used data from the ongoing REACH Registry, an observational study of outpatients with atherothrombosis (established coronary artery disease [CAD], cerebrovascular disease [CVD], or peripheral arterial disease [PAD]), or with at least three atherothrombotic risk factors from 44 countries. The aim was to determine outcome events after 3 years of follow-up. All patients were seen annually (every 6 months in the United States) to determine the occurrence of events such as myocardial infarction (MI), stroke, cardiovascular (CV) death, or hospitalization for vascular reasons.
Results:
As of March 2009, 3-year outcomes were available for 38 909 patients (81% of those eligible for follow-up), including 32 247 with symptomatic disease. Among the symptomatic patients, 92% were taking antithrombotic agents and 76% were on lipid-lowering therapy. For MI/stroke/CV death, the 1- and 3-year event rates for all patients were 4.2% and 11.0%, respectively. Event rates (MI/stroke/CV 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 6.2%, p<0.001). The 1- and 3-year rates of MI/stroke/CV death/hospitalization were 14.4% and 28.4%, respectively, for patients with symptomatic disease. Hospitalization for a vascular event other than MI/stroke/CV death was common at 3 years, with rates of 19.0% for the entire cohort, 33.8% for PAD, and 23.0% for CAD. For patients with symptomatic vascular disease in one vascular bed vs multiple vascular beds, the 3-year event rates for MI/stroke/CV death/hospitalization were 25.5% vs 40.5% (p<0.001).
Conclusions:
Despite contemporary therapy, outpatients with symptomatic atherothrombotic vascular disease still experience high rates of recurrent events and hospitalizations. This patient population has a very high utilization rate of medical resources and should be targeted for improved disease-prevention efforts.
Report:
Notes to editor
This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.