In high CRP AF and stable CAD patients, rivaroxaban monotherapy reduced primary events by 57% versus combination therapy (HR 2.31; 1-year rates 3.10% vs 5.80%).
Does rivaroxaban monotherapy reduce thrombotic events and all-cause mortality compared to combination therapy in patients with atrial fibrillation and stable coronary artery disease stratified by baseline CRP levels?
In patients with atrial fibrillation and stable coronary artery disease, rivaroxaban monotherapy is associated with lower risks of ischemic events compared to combination therapy specifically in those with high baseline CRP levels.
Absolute Event Rate: 0% vs 0%
Abstract Background Elevated C-reactive protein (CRP) levels are associated with worse outcomes in patients with atrial fibrillation (AF) and coronary artery disease (CAD)(1,2). In this high-risk population requiring long-term antithrombotic therapy, balancing thrombotic and bleeding risks is a clinical challenge. The AFIRE trial(3) demonstrated that rivaroxaban monotherapy was non-inferior to combination therapy in efficacy and had a lower risk of bleeding in patients with AF and stable CAD. However, whether baseline CRP levels influence clinical outcomes and the optimal antithrombotic strategy in this population remains unclear. Purpose This post-hoc analysis investigated the association between CRP levels and clinical outcomes in patients with AF and stable CAD and assessed whether the effects of rivaroxaban monotherapy versus combination therapy differ based on baseline CRP levels. Methods Of the 2,215 patients enrolled in the AFIRE trial, 1,294 with available baseline CRP values were included in this analysis. Patients were categorized into two groups based on the median CRP value: high CRP (1.0 mg/L, n=575) and low CRP (≤1.0 mg/L, n=719). The primary efficacy endpoint was a composite of thrombotic events and all-cause mortality; the primary safety endpoint was major bleeding. Outcomes were compared between CRP groups and treatment strategies. Results The high CRP group had a greater prevalence of obesity, diabetes, and peripheral artery disease. During a median follow-up of 23.5 months, clinical outcomes varied according to CRP levels and antithrombotic strategy. In the high CRP group, patients receiving combination therapy had significantly higher rates of the primary efficacy endpoint compared to those receiving monotherapy (HR 2.31, 95% CI 1.35–3.93, p=0.002; 1-year event rate: 5.80% vs. 3.10%, Figure 1A). Although major bleeding tended to be more frequent with combination therapy, the difference was not statistically significant (HR 1.99, 95% CI 0.96–4.16, p=0.066; 1-year event rate: 4.00% vs. 1.39%, Figure 1B). No significant differences were observed between the combination therapy and monotherapy groups in the low CRP group for either the primary efficacy endpoint (HR 1.06, 95% CI 0.65–1.71, p=0.820; 1-year event rate: 4.42% vs. 4.66%, Figure 2A) or major bleeding (HR 1.37, 95% CI 0.66–2.87, p=0.402; 1-year event rate: 1.68% vs. 1.74%, Figure 2B). The interaction analysis demonstrated that the relative efficacy of rivaroxaban monotherapy versus combination therapy differed significantly between the high and low CRP groups (p for interaction=0.033). Conclusion In patients with atrial fibrillation and stable coronary artery disease who exhibit high CRP levels, rivaroxaban monotherapy was associated with lower risks of both ischemic and bleeding events compared to combination therapy, supporting its potential advantage as an antithrombotic strategy for these patients.Results in the high CRP group Results in the low CRP group
Kasukabe et al. (Sat,) reported a other. In high CRP AF and stable CAD patients, rivaroxaban monotherapy reduced primary events by 57% versus combination therapy (HR 2.31; 1-year rates 3.10% vs 5.80%).