Key result
COMPASS eligible patients had higher rates of cardiovascular death, stroke, or MI than non-eligible patients (4.8 vs 2.3 per 100 person-years; aIRR 1.7, CI 1.6-1.9).
Why the study?
Although combined aspirin and rivaroxaban reduced ischaemic events in the COMPASS trial, the proportion of eligible patients and their outcomes in unselected real-world CAG populations remained unknown.
Does COMPASS trial eligibility identify a higher-risk subgroup among patients with CAD or PAD undergoing coronary angiography?
Cohort (n=52,132)
Yes
Does COMPASS trial eligibility identify a higher-risk subgroup among patients with CAD or PAD undergoing coronary angiography?
Effect estimate: aIRR 1.7 (95% CI 1.6-1.9)
Absolute Event Rate: 4.8% vs 2.3%
In a real-world coronary angiography cohort, 15% of patients were eligible for the COMPASS trial criteria and these patients had significantly higher rates of cardiovascular events compared to non-eligible patients, highlighting a high-risk population that may benefit from combined aspirin and rivaroxaban.
COMPASS eligibility identifies higher-risk CAD/PAD patients; leaves open whether rivaroxaban addition improves outcomes in this observational cohort.
AIMS: In the COMPASS trial, combined aspirin and rivaroxaban treatment reduced ischaemic events in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). We estimated the proportion of COMPASS eligible patients among unselected patients undergoing coronary angiography (CAG) and compared outcome rates among COMPASS eligible and non-eligible patients. METHODS AND RESULTS: We applied the COMPASS study criteria on patients undergoing CAG in Western Denmark (2004-11). Both COMPASS eligible and non-eligible patients had CAD/PAD and met no exclusion criteria, but only COMPASS eligible patients met the inclusion criteria. We assessed the COMPASS primary endpoint of cardiovascular death, ischaemic stroke, haemorrhagic stroke, or myocardial infarction (MI). We computed event rates and adjusted incidence rate ratios (aIRRs). Of 80 071 patients undergoing CAG, 27 939 did not have CAD or PAD and were not considered. Of the 52 132 patients remaining, 11 930 were COMPASS eligible. Rates of the primary endpoint were 4.8 (95% confidence interval 4.6-5.0) events per 100 person-years among COMPASS eligible patients and 2.3 (2.2-2.4) among COMPASS non-eligible patients [aIRR 1.7 (1.6-1.9)]. COMPASS eligible patients also had higher risks of cardiovascular death [aIRR 2.5 (2.1-3.0)], ischaemic stroke [aIRR 1.4 (1.2-1.6)], and MI [aIRR 1.9 (1.7-2.1)]. CONCLUSION: In this all-comers CAG cohort, 15% were eligible for combined aspirin and rivaroxaban treatment. COMPASS eligible patients had up to 2.5-fold higher rates of cardiovascular events than non-eligible patients. The higher incidence of ischaemic events in COMPASS eligible patients highlights an unmet need for additional preventive measures.
No takes yet. Share an insight, caveat, or question.
Würtz et al. (2019) conducted a cohort in stable coronary artery disease (CAD) or peripheral artery disease (PAD) (n=52,132). COMPASS eligibility vs. COMPASS non-eligible was evaluated on cardiovascular death, ischaemic stroke, haemorrhagic stroke, or myocardial infarction (MI) (aIRR 1.7, 95% CI 1.6-1.9). COMPASS eligible patients had higher rates of cardiovascular death, stroke, or MI than non-eligible patients (4.8 vs 2.3 per 100 person-years; aIRR 1.7, CI 1.6-1.9).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: