Prior cardiovascular interventions are not associated with worsened clinical outcomes in patients with symptomatic atherothrombosis.
To assess the effect of prior cardiovascular interventions on long-term clinical outcomes in patients with symptomatic atherothrombosis, the risk factor profiles, treatment patterns, and 24-month outcomes of patients in the United States with and without prior cardiovascular intervention (catheter-based, surgical, or lower-limb amputation) enrolled in the global REACH (REduction of Atherothrombosis for Continued Health) Registry were compared. Of the 17,521 US outpatients aged > or =45 years with established coronary artery disease, cerebrovascular disease, or peripheral artery disease enrolled in the REACH Registry between December 1, 2003 and June 1, 2004 who had > or =1 follow-up visit, 11,925 (68.1%) had a previous cardiovascular intervention. Prior intervention was most common in patients with coronary artery disease (76.7%) and least common in patients with cerebrovascular disease (14.6%) at baseline. Patients with prior cardiovascular intervention were significantly more likely to be taking antihypertensive, antithrombotic, or lipid-lowering therapies than those without prior intervention (P < 0.0001 for each therapy). However, 24-month Kaplan-Meier event rates for the composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke were similar between patients with and without prior intervention (9.10% vs. 9.00%; P = 0.49). Thus, in the US REACH Registry, prior cardiovascular intervention was not associated with an increased risk of subsequent cardiovascular ischemic events during follow-up. Patients without prior cardiovascular intervention had a lower intensity of risk factor modification at baseline and appear to represent an at-risk, undertreated population.
Boden
William E
WE
Department of Cardiology, Buffalo General and Millard Fillmore Hospitals and Division of Cardiovascular Medicine, Schools of Medicine & Public Health, State University of New York at Buffalo, NY, USA. wboden@kaleidahealth.org
Cherr
Gregory S
GS
Eagle
Kim A
KA
Cannon
Christopher P
CP
Califf
Robert M
RM
Hirsch
Alan T
AT
Alberts
Mark J
MJ
Criqui
Michael
M
Creager
Mark A
MA
Massaro
Joseph M
JM
D'Agostino
Ralph B
RB
Steg
P Gabriel
PG
Bhatt
Deepak L
DL
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology*; D016896:Treatment Outcome