How frequent are COMPASS-like patients in the real world? Insights from the reduction of atherothrombosis for continued health (REACH) registry

Abstract

The COMPASS trial compared 3 antithrombotic strategies in patients with stable CAD or PAD: Aspirin alone or a combination of Aspirin and different dose of Rivaroxaban. This trial has been stopped prematurely, due to overwhelming efficacy. These could potentially change the management of stable CAD and PAD patients. To describe the proportion of COMPASS-eligible patients in the REACH registry. To describe the reasons for ineligibility, and to compare the clinical characteristics, management and outcomes of COMPASS-eligible vs ineligible patients. REACH is an international prospective registry of patients with established stable CAD or PAD. The COMPASS inclusion and exclusion criteria were applied to the REACH population. The primary outcome was a composite of cardiovascular (CV) death, myocardial infarction (MI) and stroke. From the 65,351 patients in the overall REACH population, 24,677 were excluded because they did not have CAD or PAD, 15,885 were excluded because of missing information. The 24,969 remaining patients constituted the evaluable population. Among these, 10,983 patients were excluded because of exclusion criteria. The COMPASS-eligible population included 13,986 patients (56% of COMPASS-evaluable). Patients were excluded because: 4902 (19.6%) had a high bleeding risk (REACH score > 10), 3707 (14.9%) required AC, 5324 (21.3%) had HF, 1597 (6.4%) required DAPT due to ACS/PCI in the prior 12 months. The COMPASS-eligible population had a lower 4-year rate of CV death, non-fatal MI, or non-fatal stroke (14% [13.26–14.73] vs. 23.6% [22.54–24.64]); all-cause mortality (10.9% [10.2–11.5] vs. 22.5% [21.5–23.6]); or hospitalization for atherothrombotic events (26.7% [25.8–27.6] vs. 32.9% [31.8–34.0]), P < 0.001 ( Table 1 , Fig. 1 ). COMPASS-eligible patients represent approximately half of the spectrum of CAD/PAD patients in the real world REACH registry. COMPASS-eligible patients have a lower risk profile, and lower event rates compared to COMPASS-ineligible patients.