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Prior Cardiovascular Interventions Are Not Associated With Worsened Clinical Outcomes in Patients With Symptomatic Atherothrombosis

Boden, William E. MD*; Cherr, Gregory S. MD†; Eagle, Kim A. MD‡; Cannon, Christopher P. MD§; Califf, Robert M. MD¶; Hirsch, Alan T. MD∥; Alberts, Mark J. MD**; Criqui, Michael MD, MPH††; Creager, Mark A. MD‡‡; Massaro, Joseph M. PhD§§; D'Agostino, Ralph B. Sr PhD¶¶; Steg, P. Gabriel MD∥∥; Bhatt, Deepak L. MD, MPH***; on behalf of the REACH Registry Investigators

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine:
doi: 10.1097/HPC.0b013e3181e7f93e
Original Article

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 ≥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 ≥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.

Author Information

From the *Department of Cardiology, Buffalo General and Millard Fillmore Hospitals and Division of Cardiovascular Medicine, SUNY at Buffalo Schools of Medicine & Public Health, Buffalo, NY; †Department of Surgery, Buffalo General Hospital and SUNY at Buffalo School of Medicine, Buffalo, NY; ‡University of Michigan Cardiovascular Center, Ann Arbor, MI; §TIMI Study Group, Harvard Medical School and Cardiovascular Division, Brigham & Women's Hospital, Boston, MA; ¶Duke Translational Medicine Institute and Division of Cardiology, Duke University Medical Center, Durham, NC; ∥Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN; **The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL; ††Division of Preventive Medicine, University of California San Diego School of Medicine, San Diego, CA; ‡‡Cardiovascular Division, Brigham & Women's Hospital, Boston, MA; §§Department of Biostatistics, Boston University School of Public Health and Harvard Clinical Research Institute, Boston, MA; ¶¶Department of Mathematics and Statistics, Boston University and Harvard Clinical Research Institute, Boston, MA; ∥∥INSERM U-698, Recherche Clinique en Athérothrombose, Université Paris 7 AP-HP, Paris, France; and ***Department of Cardiology, VA Boston Healthcare System; Integrated Interventional Cardiovascular Program, Brigham & Women's Hospital; and TIMI Study Group, Harvard Medical School; Boston, MA.

This manuscript was written and edited by the authors, who take full responsibility for its content. The first draft was written by Dr. Boden and Dr. Cherr.

Reprints: William E. Boden, MD, Division of Cardiology, Buffalo General Hospital, SUNY at Buffalo School of Medicine, 100 High St, Buffalo, NY 14203. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.