title: Two-year vascular event rates in patients with symptomatic cerebrovascular disease: the REACH registry.
abstract: OBJECTIVE
  Few practice-based studies have reported vascular outcome events among patients with cerebrovascular disease (CeVD). We describe 2-year vascular outcomes among symptomatic CeVD patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry.
  
  
  METHODS
  Vascular events (stroke; myocardial infarction, MI; cardiovascular death, CV death; hospitalization) were studied among symptomatic CeVD patients from a prospective cohort of stable outpatients with established atherothrombosis or ≥3 atherothrombotic risk factors.
  
  
  RESULTS
  Of the 69,055 patients in REACH, 18,992 (28%) had symptomatic CeVD, of which outcome data were available for 18,189 patients. At 2 years, the frequency of non-fatal stroke was 5.93% (95% CI 5.22-6.64), non-fatal MI 2.21% (95% CI 1.65-2.76), CV death 4.45% (95% CI 3.66-5.22), combined vascular endpoint 11.48% (95% CI 10.46-12.49), and all deaths 7.39% (95% CI 6.34-8.42). The frequency of stroke, MI, CV death, or hospitalization for atherothrombotic events was 21.05% (95% CI 20.05-22.03). Event rates were lowest among patients with CeVD alone and highest among patients with CeVD, coronary artery disease, and peripheral artery disease. Other predictors of the primary outcome were increasing age, history of diabetes, current smoking, asymptomatic carotid stenosis, and carotid plaque. Outcomes were similar across geographical regions.
  
  
  CONCLUSIONS
  Symptomatic CeVD patients encounter high vascular event rates despite treatment. Recurrent nonfatal stroke is more common than nonfatal MI.
authors.affiliation: Division of Neurology, National University Hospital, Singapore.
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Blandine
authors.initials: B
authors.lastname: Pasquet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Franz
authors.initials: F
authors.lastname: Aichner
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D005060:Europe / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D009656:North America / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D013997:Time Factors