title: Residual Ischemic Risk and Its Determinants in Patients With Previous Myocardial Infarction and Without Prior Stroke or TIA: Insights From the REACH Registry.
abstract: BACKGROUND
  Although the rate of in-hospital ischemic events after myocardial infarction (MI) has dramatically decreased, long-term residual risk may remain substantial. However, most of the information on current residual risk is derived from highly selected randomized trials.
  
  
  OBJECTIVE
  In patients with previous MI and no prior ischemic stroke/transient ischemic attack (TIA), residual ischemic risk increases over time.
  
  
  METHODS
  Using the international Reduction of Atherothrombosis for Continued Health (REACH) registry, we analyzed baseline characteristics and 4-year follow-up of patients with previous MI and no history of stroke/TIA to describe annual rates of recurrent ischemic events globally and by geography. The primary outcome was the composite of cardiovascular death, MI, or stroke. Multivariate analysis identified risk factors associated with recurrent ischemic events.
  
  
  RESULTS
  Data from 16 770 patients enrolled at 5587 sites in 44 countries were analyzed. The rate of the primary outcome increased annually from 4.7% during year 1 to reach a 4-year rate of 15.1%. Compared with North America, Japan experienced lower ischemic event rates (P < 0.01), whereas Eastern Europe (P < 0.01) and the Middle East (P = 0.01) experienced higher ischemic event rates. The presence of congestive heart failure, polyvascular disease, diabetes, atrial fibrillation or flutter, and older age were associated with increased residual risk (all P < 0.01). Statin use was associated with lower ischemic risk (P < 0.01).
  
  
  CONCLUSIONS
  In this study, residual ischemic risk after MI accrued progressively up to 4 years of follow-up, emphasizing the value of intensive secondary prevention strategies to minimize residual risk.
authors: French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.|Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.
authors: Jérémie
authors: J
authors: Abtan
authors: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors: Deepak L
authors: http://orcid.org/0000-0002-1278-6245
authors: DL
authors: Bhatt
authors: French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.|Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.
authors: Yedid
authors: Y
authors: Elbez
authors: French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.|Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.
authors: Emmanuel
authors: E
authors: Sorbets
authors: University of Michigan Cardiovascular Center, Ann Arbor, Michigan.
authors: Kim
authors: K
authors: Eagle
authors: Department of Internal Medicine, Graduate School of Medicine Keio University, Tokyo, Japan.
authors: Yasuo
authors: Y
authors: Ikeda
authors: Merck & Co., Inc., Kenilworth, New Jersey.
authors: David
authors: D
authors: Wu
authors: Merck & Co., Inc., Kenilworth, New Jersey.
authors: Mary E
authors: ME
authors: Hanson
authors: Merck & Co., Inc., Kenilworth, New Jersey.
authors: Hakima
authors: H
authors: Hannachi
authors: Merck & Co., Inc., Kenilworth, New Jersey.
authors: Puneet K
authors: PK
authors: Singhal
authors: French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.|Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.|National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, United Kingdom.
authors: Philippe Gabriel
authors: PG
authors: Steg
authors: French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.|Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.
authors: Gregory
authors: G
authors: Ducrocq
mesh_terms: D000368:Aged; D001208:Asia; D005060:Europe; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D009656:North America; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013020:South America; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ischemic heart disease; ischemic risk; myocardial infarction; vorapaxar