Comparisons of Guideline-Recommended Therapies in Patients With Documented Coronary Artery Disease Having Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Versus Medical Therapy Only (from the REACH International Registry)

Steinberg, Benjamin A.; Steg, P. Gabriel; Bhatt, Deepak L.; Fonarow, Gregg C.; Zeymer, Uwe; Cannon, Christopher P.; REACH Registry Investigators,

doi:10.1016/j.amjcard.2006.12.039

« Previous Next »American Journal of Cardiology
Volume 99, Issue 9 , Pages 1212-1215, 1 May 2007

Comparisons of Guideline-Recommended Therapies in Patients With Documented Coronary Artery Disease Having Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Versus Medical Therapy Only (from the REACH International Registry)

Benjamin A. Steinberg, BA
- Thrombolysis In Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
P. Gabriel Steg, MD
- Hôpital Bichat-Claude Bernard, Services de Cardiologie, Pairs, France
- Dr. Steg has received honoraria for consulting or lectures from AstraZeneca, Bristol-Myers Squibb, Merck-Sharp Dohme, Nycomed, GlaxoSmithKline, Nycomed, Sanofi-Aventis, Servier, Takeda. His department has received a research grant from Sanofi-Aventis.
Deepak L. Bhatt, MD
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, Ohio
- Dr. Bhatt has received honoraria for consulting on scientific advisory boards from AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Millennium, Paringenix, PDL, Sanofi-Aventis, Schering Plough, The Medicines Company and honoraria for lectures from Bristol-Myers Squibb, Sanofi-Aventis, and The Medicines Company.
Gregg C. Fonarow, MD
- David Geffen School of Medicine, UCLA, Los Angeles, California
- Dr. Fonarow has received research grants from GlaxoSmithKline, Pfizer, and Amgen. He is on the speaker’s bureau or has received honoraria from Sanofi-Aventis, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Merck, Schering-Plough, AstraZeneca, Amgen, and Biosite. He is a consultant for Sanofi-Aventis, GlaxoSmithKline, Pfizer, Merck, Schering Plough, and Bristol-Myers Squibb.
Uwe Zeymer, MD
- Herzzentrum Ludwigshafen, Medizinische Klinik II, Ludwigshafen, Germany.
- Dr. Zeymer has received research grants and honoraria for speaker bureau meetings from Bristol Myers Squibb, Sanofi Aventis, and Boehringer Ingelheim.
Christopher P. Cannon, MD
- Thrombolysis In Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Dr. Cannon has received research grant support from Merck, AstraZeneca, Schering-Plough, and Accumetrics. He serves on advisory boards as a consultant with AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Schering-Plough, Pfizer, and Sanofi-Aventis.
- Corresponding author: Tel: 617-278-0146; fax: 617-734-7329.
REACH Registry Investigators
- The REACH Registry is sponsored by Sanofi-Aventis, Paris, France; Bristol-Myers Squibb, New York, New York; and the Waksman Foundation, Tokyo, Japan.

Received 2 November 2006; received in revised form 7 December 2006; accepted 7 December 2006.

To evaluate current compliance with recommendations for medical therapy in patients with coronary artery disease (CAD), the relation between previous revascularization and use of guideline-recommended therapies was investigated. From 5,400 outpatient practices in 44 countries, we compared baseline characteristics and medical therapy of 40,450 patients with documented CAD (all with previous myocardial infarction, percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], or angina pectoris) by previous revascularization status. Approximately 33% of patients had previous CABG, 33% had previous PCI, and 33% had no previous revascularization. Patients with previous CABG were older and often men and diabetic. Patients with previous PCI were the youngest. Guideline-recommended medical therapy use was significantly higher in those with previous revascularization. Antiplatelet therapy in medically managed patients was 80% versus 86% and 91% for those with previous CABG or PCI, respectively. Use of any lipid-lowering agent in those with previous CABG or PCI was 86% in the 2 groups versus 70% in patients who were medically managed. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were used in similar ratios among groups. Previous revascularization appears to be associated with better use of guideline-recommended medical treatment. These trends were similar for patients from the United States versus everywhere else. In conclusion, use of evidence-based, guideline-recommended therapies in outpatients with CAD needs to improve, especially in medically managed patients.