The following is a summary of “Impact of Low-Dose Rivaroxaban Plus Aspirin on Myocardial Infarction in Patients With Peripheral Artery Disease With and Without Concomitant Coronary Artery Disease: Insights From VOYAGER PAD,” published in the November 2023 issue of Cardiology by Canonico et al.
The impact of rivaroxaban on ischemic outcomes in peripheral artery disease(PAD) patients(pts) with and without coronary artery disease (CAD) is unclear. Researchers aimed to compare the effectiveness of rivaroxaban plus aspirin on major adverse cardiovascular events(MACE) and (MI) in PAD pts with and without coronary artery disease (CAD).
The study randomized PAD pts undergoing lower extremity revascularization to receive either rivaroxaban 2.5 mg twice daily plus aspirin or aspirin alone. MACE, a composite of MI, ischemic stroke, or cardiovascular death, was the primary outcome. Subtypes of MI were assessed following the Universal Definition, and the presence of concomitant CAD was a predefined subgroup.
Among 6,564 symptomatic PAD pts randomized, 32% (2,083) had documented CAD at baseline. The efficacy of rivaroxaban plus aspirin in preventing MACE was more pronounced in those with CAD compared to those without CAD (HR 0.79, 95% CI 0.62 – 1.00 vs HR 1.12, 95% CI 0.92 – 1.36; p-interaction 0.03). The risk of MI with rivaroxaban plus aspirin was lower for those with CAD compared to without CAD pts(HR 0.78, 95% CI 0.56 – 1.10 vs HR 0.96, 95% CI 0.69 – 1.34; p-interaction 0.39). Analyzing MI subtypes, the impact of rivaroxaban plus aspirin on type 1 MI was consistent regardless of CAD status (HR 0.91, 95% CI 0.58-1.42)and without CAD (HR 0.74, 95% CI 0.74 – 1.11, p-interaction 0.50), while a trend toward benefit was observed for Type 2 MI in patients with CAD (HR 0.71, 95% CI 0.41-1.24), but not in those without CAD (HR 1.66, 95% CI 0.89-3.09; P-interaction 0.0475). Type 4 MI incidence was infrequent, irrespective of CAD.
The study found that rivaroxaban plus aspirin consistently reduced MACE and Type 2 MI in PAD and CAD patients undergoing lower extremity revascularization(LER).
Source: abstractsonline.com/pp8/#!/10871/presentation/13103
