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Darmon A, Ducrocq G, Jasilek A, Feldman L, Sorbets E, Ferrari R, Ford I, Tardif JC, Tendera M, Fox KM, Steg PG. Use of risk scores to identify lower and higher risk subsets among COMPASS-eligible patients with chronic coronary syndromes. Insights from the CLARIFY registry. Clin Cardiol 2020; 44:58-65. [PMID: 33274779 PMCID: PMC7803362 DOI: 10.1002/clc.23505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background The COMPASS trial showed a reduction of ischemic events with low‐dose rivaroxaban and aspirin in chronic coronary syndromes (CCS) compared with aspirin alone, at the expense of increased bleeding. Hypothesis The CHA2DS2VaSc Score, REACH Recurrent Ischemic (RIS), and REACH Bleeding Risk Score (BRS) could identify patients with a favorable trade‐off between ischemic and bleeding events, among COMPASS‐eligible patients. Methods We identified the COMPASS‐eligible population within the CLARIFY registry (>30.000 patients with CCS). High‐bleeding risk patients (REACH BRS > 10) were excluded, as in the COMPASS trial. Patients were categorized as low (0–1) or high (≥ 2) CHA2DS2VaSc; low (0–12) or intermediate (13–19) REACH RIS, and low (0–6) or intermediate (7–10) REACH BRS. Ischemic outcome was the composite of cardiovascular death, myocardial infarction or stroke. Bleeding was defined as serious bleeding (haemorrhagic stroke, hospitalization for bleeding, transfusion). Results The COMPASS‐eligible population comprised 5.142 patients with ischemic and bleeding outcome of 2.3 (2.1–2.5) and 0.5 (0.4–0.6) per 100 patient‐years, respectively. Patients with intermediate REACH RIS (n = 1934 [37.6%]) had the higher ischemic risk (3.0 [2.6–3.4]) with similar bleeding risk (0.5 [0.4–0.7]) as the overall population. Patients with low CHA2DS2VaSc (n = 229 [4.4%]) had a very low ischemic risk (0.6 [0.3–1.3]) with similar bleeding risk (0.5 [0.2–1.1]). Conclusions Intermediate REACH RIS identified potential optimal candidates for adjunction of low‐dose rivaroxaban while patients with low CHA2DS2VaSc score .appears unlikely to benefit from the COMPASS regimen. None of the three risk scores predicted the occurrence of serious bleeding.
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Affiliation(s)
- Arthur Darmon
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, Paris, France
| | - Gregory Ducrocq
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, Paris, France
| | - Adam Jasilek
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Laurent Feldman
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, Paris, France
| | - Emmanuel Sorbets
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôtel Dieu, Centre de Diagnostic et de Thérapeutique, Paris, France.,INSERM U-1148, Laboratory for Vascular Translational Science, Paris, France
| | - Roberto Ferrari
- Department of Cardiology, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Kim M Fox
- National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, UK
| | - Philippe Gabriel Steg
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, Paris, France.,INSERM U-1148, Laboratory for Vascular Translational Science, Paris, France.,National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, UK
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