Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry.

Abtan, Jérémie; Bhatt, Deepak L; Elbez, Yedid; Sorbets, Emmanuel; Eagle, Kim; Reid, Christopher M; Baumgartner, Iris; Wu, David; Hanson, Mary E; Hannachi, Hakima; Singhal, Puneet K; Steg, Philippe Gabriel; Ducrocq, Gregory (2017). Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry. Clinical cardiology, 40(9), pp. 710-718. Wiley 10.1002/clc.22721

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BACKGROUND Patients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited. HYPOTHESIS We analyzed baseline characteristics and 4-year follow-up of patients enrolled in the international REduction of Atherothrombosis for Continued Health (REACH) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. METHODS The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. RESULTS The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%-5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates (P < 0.01) vs North America. Renal impairment (P < 0.01), congestive heart failure (P < 0.01), history of diabetes (P < 0.01), history of myocardial infarction (P = 0.01), vascular disease (single or poly, P < 0.01), and older age (P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk (P = 0.03). The limb ischemic event rate was 5.7% at 2 years. CONCLUSIONS Four-year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Baumgartner, Iris

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0160-9289

Publisher:

Wiley

Language:

English

Submitter:

Catherine Gut

Date Deposited:

17 Jul 2017 14:36

Last Modified:

25 Sep 2017 01:31

Publisher DOI:

10.1002/clc.22721

PubMed ID:

28520087

Uncontrolled Keywords:

Ischemic Risk; Peripheral Artery Disease; Vorapaxar

BORIS DOI:

10.7892/boris.100896

URI:

https://boris.unibe.ch/id/eprint/100896

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