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

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Title: Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry.
Authors: Abtan, J
Bhatt, DL
Elbez, Y
Sorbets, E
Eagle, K
Reid, CM
Baumgartner, I
Wu, D
Hanson, ME
Hannachi, H
Singhal, PK
Steg, PG
Ducrocq, G
REACH Registry Investigators
Item Type: Journal Article
Abstract: 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.
Issue Date: 22-Sep-2017
Date of Acceptance: 30-Mar-2017
URI: http://hdl.handle.net/10044/1/51648
DOI: https://dx.doi.org/10.1002/clc.22721
ISSN: 0160-9289
Publisher: Wiley
Start Page: 710
End Page: 718
Journal / Book Title: Clinical Cardiology
Volume: 40
Issue: 9
Copyright Statement: This is an open access article freely available at https://dx.doi.org/10.1002/clc.22721
Keywords: Ischemic Risk
Peripheral Artery Disease
Vorapaxar
REACH Registry Investigators
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Open Access location: http://onlinelibrary.wiley.com/doi/10.1002/clc.22721/epdf
Appears in Collections:National Heart and Lung Institute