Rivaroxaban Plus Aspirin Versus Aspirin Alone in Patients With Prior Percutaneous Coronary Intervention (COMPASS-PCI)

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Trials

Background:

• The COMPASS trial established dual pathway inhibition (DPI) with rivaroxaban and aspirin as effective in reducing major adverse cardiovascular events (MACE) and mortality in patients with chronic coronary syndromes or peripheral arterial disease.
• The efficacy and safety of DPI in patients with a history of percutaneous coronary intervention (PCI) remained unaddressed by the primary COMPASS trial findings.

Purpose of the Study:

• To investigate the effectiveness and safety of DPI (rivaroxaban plus aspirin) compared to aspirin alone in patients with chronic coronary syndromes who have undergone previous PCI.
• To analyze the impact of the timing of previous PCI on the outcomes of DPI therapy.

Main Methods:

• A prespecified subgroup analysis of the COMPASS trial was conducted, focusing on patients with chronic coronary syndrome.
• Outcomes were compared between patients treated with DPI and those treated with aspirin alone, specifically examining subgroups with and without prior PCI.
• For patients with prior PCI, treatment effects were assessed based on the time elapsed since the intervention.

Main Results:

• In patients with prior PCI, DPI significantly reduced MACE (4.0% vs. 5.5%) and mortality (2.5% vs. 3.5%) compared to aspirin alone, with consistent benefits observed regardless of the time since PCI.
• These benefits were mirrored in patients without prior PCI, demonstrating consistent efficacy across both groups (MACE: 4.4% vs. 5.7%; mortality: 4.1% vs. 5.0%).
• DPI was associated with an increased risk of major bleeding in both patient groups (PCI: 3.3% vs. 2.0%; no PCI: 2.9% vs. 1.8%).

Conclusions:

• Dual pathway inhibition with rivaroxaban and aspirin provides consistent reductions in MACE and mortality for patients with chronic coronary syndromes, irrespective of prior PCI history or the time elapsed since PCI.
• The increased risk of major bleeding associated with DPI therapy must be carefully considered in both patient populations.
• The findings support the use of DPI in selected patients with chronic coronary syndromes and a history of PCI, balancing efficacy with bleeding risk.