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Ph. Gabriel Steg, MD; Deepak L. Bhatt, MD; Peter W. F. Wilson, MD; Ralph D’Agostino, Sr, MD; E. Magnus Ohman, MD; Joachim Röther, MD; Chiau-Suong Liau, MD, PhD; Alan T. Hirsch, MD; Jean-Louis Mas, MD; Yasuo Ikeda, MD; Michael J. Pencina, PhD; Shinya Goto, MD; for the REACH Registry Investigators

JAMA. 2007;297:1197-1206.

Context  Few data document current cardiovascular (CV) event rates in stable patients with atherothrombosis in a community setting. Differential event rates for patients with documented coronary artery disease (CAD), cerebrovascular disease (CVD), or peripheral arterial disease (PAD) or those at risk of these diseases have not been previously evaluated in a single international cohort.

Objective  To establish contemporary, international, 1-year CV event rates in outpatients with established arterial disease or with multiple risk factors for atherothrombosis.

Design, Setting, and Participants  The Reduction of Atherothrombosis for Continued Health (REACH) Registry is an international, prospective cohort of 68 236 patients with either established atherosclerotic arterial disease (CAD, PAD, CVD; n = 55 814) or at least 3 risk factors for atherothrombosis (n = 12 422), who were enrolled from 5587 physician practices in 44 countries in 2003-2004.

Main Outcome Measures  Rates of CV death, myocardial infarction (MI), and stroke.

Results  As of July 2006, 1-year outcomes were available for 95.22% (n = 64 977) of participants. Cardiovascular death, MI, or stroke rates were 4.24% overall: 4.69% for those with established atherosclerotic arterial disease vs 2.15% for patients with multiple risk factors only. Among patients with established disease, CV death, MI, or stroke rates were 4.52% for patients with CAD, 6.47% for patients with CVD, and 5.35% for patients with PAD. The incidences of the end point of CV death, MI, or stroke or of hospitalization for atherothrombotic event(s) were 15.20% for CAD, 14.53% for CVD, and 21.14% for PAD patients with established disease. These event rates increased with the number of symptomatic arterial disease locations, ranging from 5.31% for patients with risk factors only to 12.58% for patients with 1, 21.14% for patients with 2, and 26.27% for patients with 3 symptomatic arterial disease locations (P<.001 for trend).

Conclusions  In this large, contemporary, international study, outpatients with established atherosclerotic arterial disease, or at risk of atherothrombosis, experienced relatively high annual CV event rates. Multiple disease locations increased the 1-year risk of CV events.

Author Affiliations: Département de Cardiologie, Hôpital Bichat-Claude Bernard, Paris, France (Dr Steg); Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio (Dr Bhatt); Cardiology Division, Emory University School of Medicine, Atlanta, Ga (Dr Wilson); Statistics and Consulting Unit, Department of Mathematics and Statistics, Boston University, Boston, Mass (Drs D’Agostino and Pencina); Division of Cardiology, Duke University, Durham, NC (Dr Ohman); Department of Neurology, Klinikum Minden, Minden, Germany (Dr Röther); Department of Internal Medicine, National Taiwan University Hospital and School of Medicine, Taipei, Taiwan (Dr Liau);Minneapolis Heart Institute Foundation and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (Dr Hirsch); Service de Neurologie, Centre Raymond Garcin, Hôpital Sainte-Anne, Paris, France (Dr Mas); Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan (Dr Ikeda); and Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan (Dr Goto).

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