TY - JOUR
T1 - Net clinical benefit of extended dual pathway inhibition according to baseline risk in patients with chronic coronary syndrome
T2 - a COMPASS substudy
AU - Würtz, Morten
AU - Olesen, Kevin Kris Warnakula
AU - Bhatt, Deepak L
AU - Yusuf, Salim
AU - Muehlhofer, Eva
AU - Eikelboom, John W
AU - Maeng, Michael
N1 - Publisher Copyright:
© 2024 Oxford University Press. All rights reserved.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Aims Guidelines recommend extended dual pathway inhibition (DPI) with aspirin and rivaroxaban in patients with chronic coronary syndrome (CCS) at high ischaemic risk. The CHADS-P2A2RC score improves risk prediction and enables antithrombotic treatment allocation in these patients. This study evaluated the net clinical benefit of DPI treatment according to baseline risk as classified by the CHADS-P2A2RC score in patients with CCS included in the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial. Methods and COMPASS patients with CCS (n = 14 670), randomized to aspirin alone or DPI, were stratified according to cardiovascuresults lar risk using the CHADS-P2A2RC score. Endpoints were major adverse cardiovascular events (MACE), all-cause death, fatal/critical organ bleeding, and composite adverse events (MACE and bleeding). Net clinical benefit was the 30-month risk difference of MACE and bleeding. Thirty-month incidences of MACE [7.9% vs. 3.9%, hazard ratio (HR) 2.01, 95% confidence interval (CI) 1.83–2.18] and fatal/critical organ bleeding (1.2% vs. 0.8%, HR 1.49, 95% CI 1.06–1.92) were higher in high-risk (CHADS-P2A2RC ≥ 4) than in low/moderate-risk (CHADS-P2A2RC < 4) patients. DPI reduced MACE (low/moderate risk: HR 0.62, 95% CI 0.47–0.82; high risk: HR 0.82, 95% CI 0.68–0.99, P for interaction 0.09) and all-cause death (low/moderate risk: HR 0.65, 95% CI 0.46–0.91; high risk: HR 0.81, 95% CI 0.65–1.00, P for interaction 0.29), without substantially increasing fatal/critical organ bleeding (low/moderate risk: HR 1.35, 95% CI 0.72–2.53; high risk: HR 1.18, 95% CI 0.73–1.90, P for interaction 0.73). DPI provided net clinical benefit of similar magnitude in low/moderate-risk (−1.81%, 95% CI −3.00 to −0.62) and high-risk (−1.96%, 95% CI −3.60 to −0.33) CCS patients. Conclusion As classified by the CHADS-P2A2RC score, low/moderate- and high-risk patients with CCS derived similar net clinical benefit and reduction in all-cause death from DPI treatment.
AB - Aims Guidelines recommend extended dual pathway inhibition (DPI) with aspirin and rivaroxaban in patients with chronic coronary syndrome (CCS) at high ischaemic risk. The CHADS-P2A2RC score improves risk prediction and enables antithrombotic treatment allocation in these patients. This study evaluated the net clinical benefit of DPI treatment according to baseline risk as classified by the CHADS-P2A2RC score in patients with CCS included in the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial. Methods and COMPASS patients with CCS (n = 14 670), randomized to aspirin alone or DPI, were stratified according to cardiovascuresults lar risk using the CHADS-P2A2RC score. Endpoints were major adverse cardiovascular events (MACE), all-cause death, fatal/critical organ bleeding, and composite adverse events (MACE and bleeding). Net clinical benefit was the 30-month risk difference of MACE and bleeding. Thirty-month incidences of MACE [7.9% vs. 3.9%, hazard ratio (HR) 2.01, 95% confidence interval (CI) 1.83–2.18] and fatal/critical organ bleeding (1.2% vs. 0.8%, HR 1.49, 95% CI 1.06–1.92) were higher in high-risk (CHADS-P2A2RC ≥ 4) than in low/moderate-risk (CHADS-P2A2RC < 4) patients. DPI reduced MACE (low/moderate risk: HR 0.62, 95% CI 0.47–0.82; high risk: HR 0.82, 95% CI 0.68–0.99, P for interaction 0.09) and all-cause death (low/moderate risk: HR 0.65, 95% CI 0.46–0.91; high risk: HR 0.81, 95% CI 0.65–1.00, P for interaction 0.29), without substantially increasing fatal/critical organ bleeding (low/moderate risk: HR 1.35, 95% CI 0.72–2.53; high risk: HR 1.18, 95% CI 0.73–1.90, P for interaction 0.73). DPI provided net clinical benefit of similar magnitude in low/moderate-risk (−1.81%, 95% CI −3.00 to −0.62) and high-risk (−1.96%, 95% CI −3.60 to −0.33) CCS patients. Conclusion As classified by the CHADS-P2A2RC score, low/moderate- and high-risk patients with CCS derived similar net clinical benefit and reduction in all-cause death from DPI treatment.
KW - Aspirin
KW - Chronic coronary syndrome
KW - Coronary artery disease
KW - Myocardial infarction
KW - Platelet inhibitors
KW - Rivaroxaban
KW - Risk Assessment
KW - Humans
KW - Middle Aged
KW - Male
KW - Treatment Outcome
KW - Purinergic P2Y Receptor Antagonists/adverse effects
KW - Hemorrhage/chemically induced
KW - Aspirin/adverse effects
KW - Factor Xa Inhibitors/adverse effects
KW - Rivaroxaban/adverse effects
KW - Time Factors
KW - Platelet Aggregation Inhibitors/adverse effects
KW - Female
KW - Aged
KW - Heart Disease Risk Factors
KW - Dual Anti-Platelet Therapy/adverse effects
KW - Chronic Disease
UR - http://www.scopus.com/inward/record.url?scp=85194162936&partnerID=8YFLogxK
U2 - 10.1093/ehjcvp/pvae017
DO - 10.1093/ehjcvp/pvae017
M3 - Journal article
C2 - 38453426
SN - 2055-6837
VL - 10
SP - 201
EP - 209
JO - European heart journal - Cardiovascular pharmacotherapy
JF - European heart journal - Cardiovascular pharmacotherapy
IS - 3
ER -