Prior cardiovascular interventions are not associated with worsened clinical outcomes in patients with symptomatic atherothrombosis

William E. Boden, Gregory S. Cherr, Kim A. Eagle, Christopher P. Cannon, Robert M. Califf, Alan T. Hirsch, Mark J. Alberts, Michael Criqui, Mark A. Creager, Joseph M. Massaro, Ralph B. D'agostino, P. Gabriel Steg, Deepak L. Bhatt

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)116-125
Number of pages10
JournalCritical pathways in cardiology
Volume9
Issue number3
DOIs
StatePublished - Sep 1 2010

Keywords

  • atherosclerosis
  • cardiovascular intervention
  • cardiovascular outcomes
  • secondary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Boden, W. E., Cherr, G. S., Eagle, K. A., Cannon, C. P., Califf, R. M., Hirsch, A. T., Alberts, M. J., Criqui, M., Creager, M. A., Massaro, J. M., D'agostino, R. B., Steg, P. G., & Bhatt, D. L. (2010). Prior cardiovascular interventions are not associated with worsened clinical outcomes in patients with symptomatic atherothrombosis. Critical pathways in cardiology, 9(3), 116-125. https://doi.org/10.1097/HPC.0b013e3181e7f93e