Suárez Carmen, Polo Iluminada García, Ibáñez Patricia
Hospital de la Princesa, Madrid, España.
Med Clin (Barc). 2009 Sep;132 Suppl 2:10-4. doi: 10.1016/S0025-7753(09)71746-4.
Atherothrombosis is one of the main causes of death worldwide. In Spain, as in other countries, this disease is a major public health problem, constituting a healthcare priority. The aim of the REduction of Atherothrombosis for Continued Health (REACH) registry is to analyze the long-term risk of atherothrombotic episodes in the at-risk population, evaluate the importance of cross risk, and define the prognostic factors of atherothrombotic episodes. More than 68,000 patients in more than 5,000 centers in 44 countries have been included in the REACH registry, of which 2,252 live in Spain. As observed internationally, in Spanish patients the complication rate at only 1-year of follow-up was high. The annual overall mortality rate in patients with established vascular disease or under primary prevention but with high atherothrombotic risk, represented by patients with risk factors only, was 3.57% and 1.98%, respectively, while that of cardiovascular mortality was 2.69% and 0.62%. In the subgroups of coronary artery disease (CAD), cerebral vascular disease (CVD) and peripheral artery disease (PAD) rates according to the affected territory were 3.47%, 2.78% and 1.46%, respectively. Involvement of more than one territory was clearly a poor prognostic factor: the annual complications rate increased according to whether 0, 1, 2, or 3 vascular beds were diseased for cardiovascular mortality (0.62%, 2.46%, 3.55% and 4.32%, respectively, p<0.05) and for cardiovascular mortality, plus myocardial infarction, plus stroke, plus hospitalization for cardiovascular reasons these rates were 5.50%, 4.18%, 20.59% and 19.40%. Importantly, these patients have a poor prognosis even in the short-term, especially those with established vascular disease; furthermore, the greater the number of diseased vascular beds, the poorer the prognosis. This situation must therefore be improved by earlier identification of at-risk individuals and by optimizing both primary and secondary preventive measures.
动脉粥样硬化血栓形成是全球主要死因之一。在西班牙，与其他国家一样，这种疾病是一个重大的公共卫生问题，是医疗保健的重点。“降低动脉粥样硬化血栓形成以持续健康”（REACH）注册研究的目的是分析高危人群中动脉粥样硬化血栓形成事件的长期风险，评估交叉风险的重要性，并确定动脉粥样硬化血栓形成事件的预后因素。44个国家5000多个中心的68000多名患者被纳入REACH注册研究，其中2252名居住在西班牙。正如在国际上观察到的那样，西班牙患者仅1年随访时的并发症发生率就很高。在已确诊血管疾病或处于一级预防但动脉粥样硬化血栓形成风险高的患者中，仅以有危险因素的患者为代表，其年总死亡率分别为3.57%和1.98%，而心血管死亡率分别为2.69%和0.62%。在冠状动脉疾病（CAD）、脑血管疾病（CVD）和外周动脉疾病（PAD）亚组中，根据受累区域计算的发生率分别为3.47%、2.78%和1.46%。多个区域受累显然是一个不良预后因素：心血管死亡率方面，根据0、1、2或3个血管床患病情况，年并发症发生率分别为0.62%、2.46%、3.55%和4.32%（p<0.05）；对于心血管死亡率、心肌梗死、中风以及因心血管原因住院，这些发生率分别为5.50%、4.18%、20.59%和19.40%。重要的是，即使在短期内，这些患者的预后也很差，尤其是那些已确诊血管疾病的患者；此外，患病血管床数量越多，预后越差。因此，必须通过更早识别高危个体以及优化一级和二级预防措施来改善这种情况。
