Abstract 14419: Natural History of Atherothrombotic Events According to the Primary Diseased Vascular Bed - Insights from the TRA2P-TIMI 50 Trial
Background: In clinical practice and research, patients with coronary, cerebral, or peripheral vascular disease are commonly grouped together with respect to their overall CV risk and potential treatment options, due to a shared underlying atherothrombotic pathobiology. Whether this similarity results in analogous risks for recurrent individual ischemic events, such as MI or stroke, is less certain.
Methods: This analysis includes 13,244 pts with a history of MI within the prior 2 weeks to 12 months (MI, n=8881), ischemic stroke (IS) within the prior 2 weeks to 12 months (n=2448), or peripheral arterial disease (PAD) (n=1895) assigned to placebo in the TRA 2°P-TIMI 50 trial. Event rates are presented as 3-yr KM estimates.
Results: Pts with prior MI were more likely to be younger, male, and have a history of coronary revascularization but less likely to have diabetes, HTN, or impaired renal function. Pts with PAD and prior IS had the highest rate of CV death/MI/Stroke (11.9% and 11.7%, respectively) compared to prior MI (9.7%) (p=0.006). In patients with IS, the rate of recurrent stroke was 7.5% compared to a rate of MI of 2.4%. Conversely, in pts with prior MI, the rate of IS was 1.6% compared to a MI rate of 7.0%. The risk of IS and MI was more similar among pts with PAD. Moreover, PAD pts had the highest risk of CV death (5.4%). (Figure) Moderate/Severe GUSTO bleeding occurred more frequently in pts with PAD (4.5%), than IS (2.4%) and MI (2.1%) (p<0.001).
Conclusions: Despite similar pathobiologic origins, recurrent atherothrombotic events occur most frequently in the same vascular bed as the original event, in particular for patients with prior MI and IS. Understanding the differential risks for recurrent ischemic events is important for optimizing individual treatment strategies.
- © 2012 by American Heart Association, Inc.