Coronary disease & ACSCohort study
Net clinical benefit of extended dual pathway inhibition in chronic coronary syndrome as classified by the 2024 ESC criteria: a COMPASS substudy
- COMPASS cohort
- randomized
- risk stratified using the 2024 ESC criteria
Authors' conclusion
In CCS patients, DPI reduced all-cause death and MACE while increasing major bleeding. The 2024 ESC criteria performed poorly in terms of distinguishing patients at high vs. low ischaemic risk, making them inadequate to provide guidance for DPI use.
Study context
- Population
- Patients with chronic coronary syndrome (CCS) in the COMPASS cohort, risk stratified by the 2024 ESC criteriaCCS patients randomized to aspirin alone or dual pathway inhibition (DPI)
- Participants
- 15,429 patients
- Exposure
- high risk vs low risk
Main finding
MACE, high-risk vs low-risk status · 30 months
Hazard ratio
1.33
95% CI 1.09–1.63
By group
high risk vs low risk
HR 1.33 (95% CI 1.09–1.63)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | DPI | aspirin alone | high risk | low risk | HR (CI) | |
|---|---|---|---|---|---|---|
| Composite adverse events (MACE and bleeding), high-risk vs low-risk status · 30 months | Not reported in the abstract | Not reported in the abstract | 7.1% | 5.7% | 1.31 (1.09–1.58) | |
| MACE, DPI vs aspirin alone, by risk · low risk | 0.66 (0.45–0.95) | |||||
| MACE, DPI vs aspirin alone, by risk · high risk | 0.77 (0.66.–0.91) | |||||
| All-cause death, DPI vs aspirin alone, by risk · low risk | 0.78 (0.53–1.14) | |||||
| All-cause death, DPI vs aspirin alone, by risk · high risk | 0.78 (0.64–0.94) | |||||
| Net clinical benefit (absolute risk difference combining MACE and bleeding), DPI vs aspirin alone, by risk · 30 months · low risk | 0.79 (0.56–1.11) | |||||
| Net clinical benefit (absolute risk difference combining MACE and bleeding), DPI vs aspirin alone, by risk · 30 months · high risk | 0.80 (0.69–0.93) | |||||
| 0.512Hazard ratio (log scale) |
| Outcome | risk difference (CI) | |
|---|---|---|
| Net clinical benefit (absolute risk difference combining MACE and bleeding), DPI vs aspirin alone, by risk · 30 months · low risk | −1.77% (−3.88-0.33) | |
| Net clinical benefit (absolute risk difference combining MACE and bleeding), DPI vs aspirin alone, by risk · 30 months · high risk | −2.06% (−3.20-0.91) | |
| −4−202Difference (linear scale) |
- Major adverse cardiovascular events (MACE), DPI vs aspirin alone, by risk: P-value for interaction 0.42
- All-cause death, DPI vs aspirin alone, by risk: P-value for interaction 0.99
- Net clinical benefit (absolute risk difference combining MACE and bleeding), DPI vs aspirin alone, by risk: P-value for interaction 0.94
All-cause death or bleeding, high-risk vs low-risk status
- High-risk status not associated with higher all-cause death or bleeding
Original publication
Net clinical benefit of extended dual pathway inhibition in chronic coronary syndrome as classified by the 2024 ESC criteria: a COMPASS substudy. Eur Heart J Cardiovasc Pharmacother. Published 30 January 2026. doi:10.1093/ehjcvp/pvag008
Summarised from the published abstract; every number is checked against it