Abstract
BackgroundPatients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited.HypothesisWe 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.MethodsThe 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.ResultsThe 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.ConclusionsFour‐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.
Highlights
Over 202 million people worldwide were estimated to be living with peripheral artery disease (PAD) in 2010, with estimated prevalence rates of 9% in North America and 11% in Europe.[1]
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
A subgroup analysis of the PLATO (Study of PLATelet inhibition and patient Outcomes) trial showed that the benefit of ticagrelor over clopidogrel in acute coronary syndrome patients was consistent in the subgroup of PAD patients compared with the global population.[36]
Summary
Over 202 million people worldwide were estimated to be living with peripheral artery disease (PAD) in 2010, with estimated prevalence rates of 9% in North America and 11% in Europe.[1]. To address gaps in evidence for characterization of longer-term ischemic risk in PAD patients, we analyzed 4-year data from the REduction of Atherothrombosis for Continued Health (REACH) Registry, an international registry of atherothrombosis[7,8,9] in patients with symptomatic PAD with no history of stroke or transient ischemic attack (TIA), focusing on both systemic (MI, stroke, and CV death) and limb ischemic complications (lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD). Patients with prior stoke or TIA were excluded, because the risk and benefit balance of antithrombotic agents in this population is specific and has been previously published as a separate analysis.[10] The objectives of the present study were to (1) describe annual rates of systemic ischemic events (MI, stroke, and CV death) over 4 years globally and by geographic region, and to identify associated risk factors; and (2) to describe limb ischemic event rates (a composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) over 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
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