When compared with conventional coronary artery bypass grafting with cardiopulmonary bypass, off-pump coronary artery bypass grafting achieved similar completeness of revascularization, similar in-hospital and 30-day outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury.

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sis are at elevated risk of ischemic events but, depending on their specific manifestations of atherothrombosis, may have varying degrees of future risk for ischemic events. Accurate knowledge of the major determinants of subsequent ischemic risk would be extremely useful, both for clinical and investigational purposes. Several recent clinical trials of new agentsinacutecoronarysyndromes,stable atherosclerosis,anddiabetesmellitushave reported event rates lower than initially projected. 1-6 Theabilitytoidentifypatients at highest risk of cardiovascular events would allow trials of novel therapies to focus on those patients most likely to derive benefit. For clinicians, the ability to identify rapidly the major determinants of risk among patients with atherosclerosis would be useful to triage novel preventive therapies toward those at the higher end of the risk spectrum. Thus, the international Reduction of Atherothrom-bosisforContinuedHealth(REACH)Registry, a contemporary data set comprising patients with various manifestations of atherosclerosis, spanning from asymptomaticadultswithriskfactors,topatients with stable atherosclerosis, to those with prior ischemic events, would be potentially useful to establish the risk of future ischemicevents.Herein,the4-yearresults of the REACH Registry are presented.

on behalf of the Reduction of Atherothrombosis for Continued Health (REACH) Registry Investigators* Background-Peripheral artery disease (PAD) is common and imposes a high risk of major systemic and limb ischemic events. The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international prospective registry of patients at risk of atherothrombosis caused by established arterial disease or the presence of Ն3 atherothrombotic risk factors. Methods and Results-We compared the 2-year rates of vascular-related hospitalizations and associated costs in US patients with established PAD across patient subgroups. Symptomatic PAD at enrollment was identified on the basis of current intermittent claudication with an ankle-brachial index (ABI) Ͻ0.90 or a history of lower-limb revascularization or amputation. Asymptomatic PAD was diagnosed on the basis of an enrollment ABI Ͻ0.90 in the absence of symptoms. Overall, 25 763 of the total 68 236 -patient REACH cohort were enrolled from US sites; 2396 (9.3%) had symptomatic and 213 (0.8%) had asymptomatic PAD at baseline. One-and cumulative 2-year follow-up data were available for 2137 (82%) and 1677 (64%) of US REACH patients with either symptomatic or asymptomatic PAD, respectively. At 2 years, mean cumulative hospitalization costs, per patient, were $7445, $7000, $10 430, and $11 693 for patients with asymptomatic PAD, a history of claudication, lower-limb amputation, and revascularization, respectively (Pϭ0.007). A history of peripheral intervention (lower-limb revascularization or amputation) was associated with higher rates of subsequent procedures at both 1 and 2 years. Conclusions-The economic burden of PAD is high. Recurring hospitalizations and repeat revascularization procedures suggest that neither patients, physicians, nor healthcare systems should assume that a first admission for a lower-extremity PAD procedure serves as a permanent resolution of this costly and debilitating condition. (Circ Cardiovasc Qual Outcomes. 2010;3:642-651.)

on behalf of the REACH Registry InvestigatorsBackground-Atherothrombosis is the underlying cause of cardiovascular, cerebrovascular, and peripheral arterial disease and is the leading cause of death in the industrialized world. The objectives of the present study are (1) to examine the annual costs associated with vascular events and interventions that require hospitalization, as well as long-term medication use for the management of associated risk factors, in a US population of outpatients with multiple atherothrombotic risk factors or a history of symptomatic disease and (2)