Prognosis of patients with atherothrombotic disease:: A prospective survey in a non-hospital setting

Background and purpose: Ischemic stroke, myocardial infarction and peripheral arterial disease are the clinical expression of a single underlying pathology. However, atherothrombotic diseases are often associated and little is known of the prognosis of these diseases taken as a whole. Methods: The objective of the survey was to estimate the one-year occurrence of subsequent vascular events in patients with atherothrombotic disease. We measured the occurrence of myocardial infarction, ischemic stroke and cardiovascular death. Patients were enrolled by private practice physicians in a non-hospital setting. They had to present with at least one of myocardial infarction, ischemic non-embolic stroke, and peripheral arterial disease. The Kaplan-Meier method was used to determine the event-free survival and a multivariate analysis was used to assess predictors of cardiovascular events. Results: 7783 eligible patients were enrolled by 3039 physicians. As a whole, 296 of 7783 patients (3.8%) experienced at least one ischemic event: 78 non-fatal myocardial infarction (26.4% of first events), 120 non-fatal stroke (40.5%) and 98 cardiovascular deaths (33.1%). For patients with a single location, the rate (crude percentage) of a first recurrent event was 2.9%, 4.8% and 3.2% in myocardial infarction, ischemic stroke and peripheral arterial disease; for patients with several locations the rate was 5.6%, 8.3%, 5.9%, respectively. But for patients with a single location, the one-year cumulative cardiovascular event rate observed separately in men or women, adjusted by age, was not statistically different whatever the location. Conclusions: Despite recent recommendations drawn from large clinical trials in secondary prevention, the risk of cardiovascular events remains very high in patients followed up in daily practice with a history of one or several atherothrombotic locations. (c) 2005 Elsevier Ireland Ltd. All rights reserved.