Net clinical benefit of extended dual pathway inhibition according to baseline risk in patients with chronic coronary syndrome: a COMPASS substudy
Authors' 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.
Study context
- Population
- COMPASS patients with chronic coronary syndrome, stratified by CHADS-P2A2RC score (high risk ≥4 vs low/moderate risk <4)
- Participants
- 14,670 patients
- Comparison
- Dual pathway inhibition (DPI) vs aspirin alone, by CHADS-P2A2RC risk
- Primary endpoint
- Net clinical benefit (risk difference of MACE and bleeding)
- Follow-up
- 30 months
Methodological detailssubgroup analysis by baseline risk (CHADS-P2A2RC score)
- Subgroup analysis by baseline risk (CHADS-P2A2RC score)
Primary result
As reported in the abstract
Net clinical benefit of DPI, by baseline risk
DPI vs Aspirin aloneRisk difference, % (95% CI)
Low/moderate risk (CHADS-P2A2RC < 4)
−1.81(−3.00 to −0.62)
High risk (CHADS-P2A2RC ≥ 4)
−1.96(−3.60 to −0.33)
Further findings
| Outcome | High risk (CHADS-P2A2RC ≥ 4) | Low/moderate risk (CHADS-P2A2RC < 4) | HR (95% CI) | |
|---|---|---|---|---|
| MACE with DPI, by baseline risk (subgroup)DPIvs Aspirin aloneLow/moderate risk | 0.62 (0.47–0.82) | |||
| MACE with DPI, by baseline risk (subgroup)DPIvs Aspirin aloneHigh risk | 0.82 (0.68–0.99) | |||
| All-cause death with DPI, by baseline risk (subgroup)DPIvs Aspirin aloneLow/moderate risk | 0.65 (0.46–0.91) | |||
| All-cause death with DPI, by baseline risk (subgroup)DPIvs Aspirin aloneHigh risk | 0.81 (0.65–1.00) | |||
| MACE incidence, highvs low/moderate risk · 30 months | 7.9% | 3.9% | 2.01 (1.83–2.18) | |
| 0.512Hazard ratio (log scale) |
- Major adverse cardiovascular events (MACE) with DPI, by baseline risk (subgroup): interaction P 0.09
- All-cause death with DPI, by baseline risk (subgroup): interaction P 0.29
Safety
| Outcome | High risk (CHADS-P2A2RC ≥ 4) | Low/moderate risk (CHADS-P2A2RC < 4) | HR (95% CI) | |
|---|---|---|---|---|
| Fatal/critical organ bleeding with DPI, by baseline risk (subgroup)DPIvs Aspirin aloneLow/moderate risk | 1.35 (0.72–2.53) | |||
| Fatal/critical organ bleeding with DPI, by baseline risk (subgroup)DPIvs Aspirin aloneHigh risk | 1.18 (0.73–1.90) | |||
| Fatal/critical organ bleeding incidence, highvs low/moderate risk · 30 months | 1.2% | 0.8% | 1.49 (1.06–1.92) | |
| 0.20.5125Hazard ratio (log scale) |
- Fatal/critical organ bleeding with DPI, by baseline risk (subgroup): interaction P 0.73
Original publication
Net clinical benefit of extended dual pathway inhibition according to baseline risk in patients with chronic coronary syndrome: a COMPASS substudy. Eur Heart J Cardiovasc Pharmacother. Published 7 March 2024. doi:10.
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