CONTEXT: Clinicians and trialists have difficulty with identifying which patients are highest risk for cardiovascular events. Prior ischemic events, polyvascular disease, and diabetes mellitus have all been identified as predictors of ischemic events, but their comparative contributions to future risk remain unclear. OBJECTIVE: To categorize the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis using simple clinical descriptors. DESIGN, SETTING, AND PATIENTS: Outpatients with coronary artery disease, cerebrovascular disease, or peripheral arterial disease or with multiple risk factors for atherothrombosis were enrolled in the global Reduction of Atherothrombosis for Continued Health (REACH) Registry and were followed up for as long as 4 years. Patients from 3647 centers in 29 countries were enrolled between 2003 and 2004 and followed up until 2008. Final database lock was in April 2009. MAIN OUTCOME MEASURES: Rates of cardiovascular death, myocardial infarction, and stroke. RESULTS: A total of 45,227 patients with baseline data were included in this 4-year analysis. During the follow-up period, a total of 5481 patients experienced at least 1 event, including 2315 with cardiovascular death, 1228 with myocardial infarction, 1898 with stroke, and 40 with both a myocardial infarction and stroke on the same day. Among patients with atherothrombosis, those with a prior history of ischemic events at baseline (n = 21,890) had the highest rate of subsequent ischemic events (18.3%; 95% confidence interval [CI], 17.4%-19.1%); patients with stable coronary, cerebrovascular, or peripheral artery disease (n = 15,264) had a lower risk (12.2%; 95% CI, 11.4%-12.9%); and patients without established atherothrombosis but with risk factors only (n = 8073) had the lowest risk (9.1%; 95% CI, 8.3%-9.9%) (P < .001 for all comparisons). In addition, in multivariable modeling, the presence of diabetes (hazard ratio [HR], 1.44; 95% CI, 1.36-1.53; P < .001), an ischemic event in the previous year (HR, 1.71; 95% CI, 1.57-1.85; P < .001), and polyvascular disease (HR, 1.99; 95% CI, 1.78-2.24; P < .001) each were associated with a significantly higher risk of the primary end point. CONCLUSION: Clinical descriptors can assist clinicians in identifying high-risk patients within the broad range of risk for outpatients with atherothrombosis.
CONTEXT: Clinicians and trialists have difficulty with identifying which patients are highest risk for cardiovascular events. Prior ischemic events, polyvascular disease, and diabetes mellitus have all been identified as predictors of ischemic events, but their comparative contributions to future risk remain unclear. OBJECTIVE: To categorize the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis using simple clinical descriptors. DESIGN, SETTING, AND PATIENTS: Outpatients with coronary artery disease, cerebrovascular disease, or peripheral arterial disease or with multiple risk factors for atherothrombosis were enrolled in the global Reduction of Atherothrombosis for Continued Health (REACH) Registry and were followed up for as long as 4 years. Patients from 3647 centers in 29 countries were enrolled between 2003 and 2004 and followed up until 2008. Final database lock was in April 2009. MAIN OUTCOME MEASURES: Rates of cardiovascular death, myocardial infarction, and stroke. RESULTS: A total of 45,227 patients with baseline data were included in this 4-year analysis. During the follow-up period, a total of 5481 patients experienced at least 1 event, including 2315 with cardiovascular death, 1228 with myocardial infarction, 1898 with stroke, and 40 with both a myocardial infarction and stroke on the same day. Among patients with atherothrombosis, those with a prior history of ischemic events at baseline (n = 21,890) had the highest rate of subsequent ischemic events (18.3%; 95% confidence interval [CI], 17.4%-19.1%); patients with stable coronary, cerebrovascular, or peripheral artery disease (n = 15,264) had a lower risk (12.2%; 95% CI, 11.4%-12.9%); and patients without established atherothrombosis but with risk factors only (n = 8073) had the lowest risk (9.1%; 95% CI, 8.3%-9.9%) (P < .001 for all comparisons). In addition, in multivariable modeling, the presence of diabetes (hazard ratio [HR], 1.44; 95% CI, 1.36-1.53; P < .001), an ischemic event in the previous year (HR, 1.71; 95% CI, 1.57-1.85; P < .001), and polyvascular disease (HR, 1.99; 95% CI, 1.78-2.24; P < .001) each were associated with a significantly higher risk of the primary end point. CONCLUSION: Clinical descriptors can assist clinicians in identifying high-risk patients within the broad range of risk for outpatients with atherothrombosis.
Authors: Eric S Ketchum; Kenneth Dickstein; John Kjekshus; Bertram Pitt; Meagan F Wong; David T Linker; Wayne C Levy Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-09-11
Authors: Emmanuel Sorbets; Julien Labreuche; Tabassome Simon; Laurent Delorme; Nicolas Danchin; Pierre Amarenco; Shinya Goto; Christophe Meune; Kim A Eagle; Deepak L Bhatt; Philippe Gabriel Steg Journal: Eur Heart J Date: 2014-03-09 Impact factor: 29.983
Authors: Dharam J Kumbhani; Ph Gabriel Steg; Christopher P Cannon; Kim A Eagle; Sidney C Smith; Shinya Goto; E Magnus Ohman; Yedid Elbez; Piyamitr Sritara; Iris Baumgartner; Subhash Banerjee; Mark A Creager; Deepak L Bhatt Journal: Eur Heart J Date: 2014-02-28 Impact factor: 29.983
Authors: J Antonio Gutierrez; Hillary Mulder; W Schuyler Jones; Frank W Rockhold; Iris Baumgartner; Jeffrey S Berger; Juuso I Blomster; F Gerry R Fowkes; Peter Held; Brian G Katona; Kenneth W Mahaffey; Lars Norgren; William R Hiatt; Manesh R Patel Journal: JAMA Netw Open Date: 2018-11-02
Authors: Dirk De Bacquer; Delphine De Smedt; Kornelia Kotseva; Catriona Jennings; David Wood; Lars Rydén; Viveca Gyberg; Bahira Shahim; Philippe Amouyel; Jan Bruthans; Almudena Castro Conde; Renata Cífková; Jaap W Deckers; Johan De Sutter; Mirza Dilic; Maryna Dolzhenko; Andrejs Erglis; Zlatko Fras; Dan Gaita; Nina Gotcheva; John Goudevenos; Peter Heuschmann; Aleksandras Laucevicius; Seppo Lehto; Dragan Lovic; Davor Miličić; David Moore; Evagoras Nicolaides; Raphael Oganov; Andrzej Pajak; Nana Pogosova; Zeljko Reiner; Martin Stagmo; Stefan Störk; Lale Tokgözoğlu; Dusko Vulic; Martin Wagner; Guy De Backer Journal: Eur J Epidemiol Date: 2018-10-23 Impact factor: 8.082
Authors: J Dawn Abbott; Manuel S Lombardero; Gregory W Barsness; Ivan Pena-Sing; L Virginia Buitrón; Premranjan Singh; Gail Woodhead; Jean-Claude Tardif; Sheryl F Kelsey Journal: Am Heart J Date: 2012-10 Impact factor: 4.749