Reduction of Atherothrombosis for Continued Health Registry - REACH Registry

Description:

The goal of the registry was to evaluate risk factors and cardiovascular event rates in patients with stable atherothrombosis.

Study Design

Patients Enrolled: 63,129
Mean Follow Up: Up to 4 years
Mean Patient Age: Mean age 68.6
Female: 36

Patient Populations:

Documented cerebrovascular disease, CAD, or peripheral vascular disease, or ≥3 risk factors, including the following: increased age, smoking, hypertension, diabetes, hypercholesterolemia, ankle-brachial index <0.9 at rest, asymptomatic carotid stenosis ≥70%, and carotid plaque

Drug/Procedures Used:

REACH was an international, prospective, observational registry that followed patients with or at high risk of atherothrombosis from 44 countries. Baseline data were collected, and patients were followed for up to 4 years.

Principal Findings:

At baseline, diabetes was present in 44.1%, hypercholesterolemia in 72.1%, and multiple risk factors in 18.3%. Patients were enrolled primarily in the outpatient setting by general practitioners (36.7%) or internists (32.8%). Percutaneous coronary intervention was performed in 3.7% of patients with coronary artery disease (CAD) and coronary artery bypass grafting in 1.3% of patients.

At 1 year, the composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke occurred in 3.5% of patients, with higher rates in symptomatic patients (3.9%) compared with asymptomatic patients with risk factors only (1.7%). By 2 years, the overall rate was 6.2%, and 6.8% in symptomatic patients. Results were similar for the composite of CV death, MI, stroke, or hospitalization for atherothrombotic events at 1 year (12.9% for all patients, 14.5% for symptomatic patients, 5.4% for risk factor only patients). By 2 years, the overall rate was 17.1%, and 19.1% in symptomatic patients.

Among the cohort with single arterial disease (CAD, CV disease, or peripheral arterial disease), CV death, MI, or stroke at 1 year occurred in 3.4% of the population compared with 6.0% in patients with polyvascular disease. The highest event rates were in patients with CAD, CV disease, and peripheral vascular disease (7.4%).

Interpretation:

Among patients with stable or at high risk for atherothrombosis, CV event rates were relatively high and increased with the number of symptomatic arterial diseases compared with patients with risk factors only. Geographic variation existed in the event rates, as did variation in age group and less so by gender.

References:

Ohman EM, Bhatt DL, Steg PG, et al. The REduction of Atherothrombosis for Continued Health (REACH) Registry: an international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design. Am Heart J. 2006 Apr;151(4):786.e1-10.

Presented by Dr. P. Gabriel Steg at the March 2006 ACC Annual Scientific Session, Atlanta, GA.

Presented by E.M. Ohman, European Society of Cardiology Scientific Congress, September 2006.

Clinical Topics: Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Aortic Surgery, Homozygous Familial Hypercholesterolemia, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine, Hypertension, Smoking

Keywords: Coronary Artery Disease, Stroke, Myocardial Infarction, Ankle Brachial Index, Risk Factors, Peripheral Arterial Disease, Hypercholesterolemia, Smoking, Percutaneous Coronary Intervention, Registries, Carotid Stenosis, Coronary Artery Bypass, Hypertension, Diabetes Mellitus, General Practitioners


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