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

Abstract

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.

Figure 1

Patient flow, drop-out, and follow-up over 3 years in the REACH Registry.

Figure 2

Type and distribution of monovascular and polyvascular disease at baseline in patients eligible for 3-year follow-up. Data labels report the number of patients with each disease type.

Figure 3

Rates of rehospitalization (excluding rehospitalization for the primary endpoint of myocardial infarction/stroke/vascular death) for symptomatic patients in REACH at 1- and 3-year follow-up. Coronary artery disease, cerebrovascular disease, and peripheral arterial disease groups include patients with single bed as well as polyvascular disease.

Figure 4

Event rates per 100 patient-years at 3 years for important vascular outcomes by the type of symptomatic disease present at study entry. Coronary artery disease, cerebrovascular disease, and peripheral arterial disease groups include patients with single bed as well as polyvascular disease.

Figure 5

Three-year rates of myocardial infarction/stroke/vascular death, and myocardial infarction/stroke/vascular death/rehospitalization for symptomatic patients with monovascular or polyvascular disease.