Use of risk scores to identify lower and higher risk subsets among COMPASS‐eligible patients with chronic coronary syndromes. Insights from the CLARIFY registry

Autor: Philippe Gabriel Steg, A. Darmon, Roberto Ferrari, Emmanuel Sorbets, Jean-Claude Tardif, Ian Ford, Gregory Ducrocq, Laurent J. Feldman, Kim Fox, Michal Tendera, Adam Jasilek
Rok vydání: 2020
Předmět:
Male
Time Factors
chronic coronary syndromes
Comorbidity
Coronary Artery Disease
030204 cardiovascular system & hematology
Severity of Illness Index
COMPASS
0302 clinical medicine
ischemic risk
Risk Factors
Registries
030212 general & internal medicine
Myocardial infarction
Low Ischemic Risk
rivaroxaban
1102 Cardiorespiratory Medicine and Haematology
Stroke
Aspirin
education.field_of_study
Framingham Risk Score
Incidence
Syndrome
General Medicine
Female
Cardiology and Cardiovascular Medicine
Switzerland
medicine.drug
medicine.medical_specialty
Population
Clinical Investigations
risk score
Risk Assessment
03 medical and health sciences
bleeding risk
Internal medicine
medicine
Humans
education
Aged
Retrospective Studies
Rivaroxaban
business.industry
medicine.disease
R1
Regimen
Cardiovascular System & Hematology
Chronic Disease
business
Follow-Up Studies
Zdroj: Clinical Cardiology
ISSN: 1932-8737
0160-9289
DOI: 10.1002/clc.23505
Popis: Background:\ud \ud 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.\ud \ud Hypothesis:\ud \ud The CHA DS VaSc 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.\ud \ud Methods\ud \ud 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) CHA DS VaSc; 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).\ud \ud Results:\ud \ud 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 CHA DS VaSc (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]).\ud \ud Conclusions:\ud \ud Intermediate REACH RIS identified potential optimal candidates for adjunction of low-dose rivaroxaban while patients with low CHA DS VaSc score .appears unlikely to benefit from the COMPASS regimen. None of the three risk scores predicted the occurrence of serious bleeding.
Databáze: OpenAIRE
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