COMPASS criteria applied to a contemporary cohort of unselected patients with stable coronary artery diseases: insights from the START registry

Abstract

Background Recently, the COMPASS trial demonstrated that dual therapy reduced cardiovascular outcomes compared with aspirin alone in patients with stable atherosclerotic disease. Methods and Results We sought to assess the proportion of patients eligible for the COMPASS trial and to compare the epidemiology and outcome of these patients with those without COMPASS inclusion or with any exclusion criteria in a contemporary, nationwide cohort of patients with stable coronary artery disease (CAD). Among the 4068 patients with detailed information allowing evaluation of eligibility, 1416 (34.8%) did not fulfill the inclusion criteria (COMPASS-Not-Included), 841 (20.7%) had exclusion criteria (COMPASS-Excluded) and the remaining 1811 (44.5%) were classified as COMPASS-Like. At 1 year, the incidence of major adverse cardiovascular event (MACE), a composite of cardiovascular death, myocardial infarction and stroke, was 0.9% in the COMPASS-Not-Included and 2.0% in the COMPASS-Like (p = 0.01), and 5.0% in the COMPASS-Excluded group (p < 0.0001 for all comparisons). Among the COMPASS-Like population, patients with multiple COMPASS enrichment criteria presented a significant increase in the risk of MACE (from 1.0% to 3.3% in those with 1 and ≥3 criteria, respectively; p = 0.012), and a modest absolute increase in major bleeding risk (from 0.2% to 0.4%, respectively; p = 0.46). Conclusions In a contemporary real-world cohort registry of stable CAD, most patients resulted as eligible for the COMPASS. These patients presented a considerable annual risk of MACE that consistently increases in the presence of multiple risk factors.

Prevalence and clinical implications of eligibility criteria for prolonged dual antithrombotic therapy in patients with PEGASUS and COMPASS phenotypes: Insights from the START-ANTIPLATELET registry

“…After applying the inclusion/exclusion criteria of the COMPASS trial to the population (n = 31,873) of the large international REduction of Atherothrombosis for Continued Health (REACH) registry, 53% of patients were found to be eligible for the COMPASS strategy [18]. In a recent analysis of a nationwide cohort, 44.5% of 4068 patients were classified as COMPASSlike patients [19]. Compared to our results, in both cases, the proportion of potentially eligible patients appears to be lower.…”

“…Based on these data and the prevalence of risk factors in our real-life population with COMPASS phenotype, we can speculate that the cardiovascular benefits observed in the trial could be amplified in realworld clinical scenarios. In a previous study by De Luca et al [19], comparing patients meeting 1 with those meeting ≥3 COMPASS criteria, showed that patients with multiple criteria had a significantly high risk of MACE (from 1.0% to 3.3%, p = 0.012) and a modest absolute increase in the risk of major bleeding (from 0.2% to 0.4%, respectively; p = 0.46) [19].…”

Low-dose rivaroxaban: can cardiovascular events be reduced?

“…In the real-world setting, the proportion of COMPASS-Eligible Patients in the REACH 16 and italian START (STable Coronary Artery Diseases RegisTry) 17 registries are well represented, in fact they are about half (52,9% in REACH and 44,5% in START Registry) ( Figure 7 ). In particular, in both registries, ischaemic outcome increased according to the number of enrichment criteria, without a significant change of safety profile (disproportionate increase in ischaemic vs. bleeding risk in patients with multiple enrichment criteria).…”

“…In COMPASS-Like population, patients with multiple enrichment criteria at inclusion (diabetes mellitus, age >65 years, asymptomatic carotid disease, PAD, history of heart failure, renal impairment, current smoking status, and history of ischaemic stroke) presented a significant increase in the risk of major adverse events, and a modest absolute increase in the rate of major bleedings. 16 , 17 Accordingly, in a post hoc analysis of the COMPASS trial subjects were classified as high-risk according to REACH scoring (two or more vascular beds affected, history of heart failure, or renal insufficiency) or CART scoring (two or more vascular beds affected, history of heart failure, or diabetes) 18 Those with high-risk features presented a lower incidence of major adverse CV events, acute limb ischaemia, or total vascular amputation when treated with DPI compared with ASA, with a similar rate of major bleeding events.…”

Type two diabetes mellitus and microvascular complications in patients with coronary artery disease: prevalence, prognosis and choice of antithrombotic therapy

“…в результате из-за опасений увеличения риска кровотечений в реальной клинической практике при выборе антитромботической терапии для больных высокого ишемического риска в сочетании с хбп часто применяется не двойная терапия, а монотерапия ацетилсалициловой кислотой. данные большого регистра больных с ибС указывают на то, что около половины больных реальной клинической практики соответствует критериям включения, которые использовались в рки COmpAss, и им показана комбинированная терапия ривароксабаном и ацетилсалициловой кислотой [72].…”