Portal de investigação
High Risk of Stroke in Patients With Worsening Heart Failure, Reduced Ejection Fraction, Coronary Heart Disease and Sinus Rhythm: Risk Prediction Score Analysis From the COMMANDER-HF Trial
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Monzo, L
- Girerd, N
- Lamiral, Z
- Anker, SD
- Cleland, JGF
- Kondo, T
- Mcmurray, JJV
- Lam, CSP
- Mehra, MR
- Veldhuisen, DJV
- Greenberg, B
- Zannad, F
Unidades de investigação
Abstract
Background: Patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm have a heightened risk of stroke. Whether anticoagulation bene fi ts these patients is uncertain. In this post hoc analysis of the A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction, or Stroke in Participants with Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure (COMMANDER-HF) trial we evaluated how a previously validated risk model consisting of 3 variables (history of prior stroke, insulin-treated diabetes, and N -terminal pro-B-type natriuretic peptide level) would perform, compared with plasma D -dimer, for stroke prediction and estimation of the bene fi t of low-dose rivaroxaban. Methods and Results: Stroke risk and treatment effect were computed across risk score and plasma D -dimer tertiles. Risk score was available in 58% of the COMMANDER-HF population ( n = 2928). Over a median follow-up of 512 days (range 342-747 days), 60 patients experienced a stroke (14.6 per 1000 patient-years). The risk model did not identify patients at higher risk of stroke and showed a low overall prognostic performance (C-index = 0.53). The effect of rivaroxaban on stroke was homogeneous across risk score tertiles ( P -interaction = .67). Among patients in whom the risk score was estimated, D -dimer was available in 2343 (80%). D -dimer had an acceptable discrimination performance for stroke prediction (C-index = 0.66) and higher plasma D -dimer concentrations were associated with higher rates of stroke (ie, tertile 3 vs tertile 1, hazard ratio 3.65, 95% confidence interval 1.59-8.39, P = .002). Treatment with low dose rivaroxaban reduced the incidence of stroke in patients at highest risk by D -dimer levels (ie, > 515 ng/mL, hazard ratio 0.42, 95% con fi dence interval 0.18-0.95, P -interaction = .074), without any safety concerns. Conclusions: In our analysis, plasma D -dimer concentrations performed better than a previously described 3-variable risk score for stroke prediction in patients with heart failure with reduced ejection fraction, a recent clinical worsening and sinus rhythm as enrolled in the COMMANDER-HF trial. In these patients, a raised plasma D -dimer concentration identified patients who might bene fi t most from rivaroxaban. ( J Cardiac Fail 2024;30:618 - 623 ) (c) 2023 Elsevier Inc. All rights reserved.
Dados da publicação
- ISSN/ISSNe:
- 1071-9164, 1532-8414
- Tipo:
- Article
- Páginas:
- 618-623
- Link para outro recurso:
- www.scopus.com
Journal of Cardiac Failure Churchill Livingstone
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Filiações
Keywords
- Stroke; risk score; HFrEF; COMMANDER-HF; sinus rhythm; D-dimer
Campos de estudo
Financiamento
Proyectos asociados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
Initiation of ARNi and SGLT2i in Patients With HFrEF: Randomized Open-label Trial (INITIATE-HFrEF) -NCT05989503
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (INITIATE-HFrEF) . Novartis . 2023
Citar a publicação
Monzo L,Girerd N,Ferreira JP,Lamiral Z,Anker SD,Cleland JGF,Kondo T,Mcmurray JJV,Lam CSP,Mehra MR,Veldhuisen DJV,Greenberg B,Zannad F. High Risk of Stroke in Patients With Worsening Heart Failure, Reduced Ejection Fraction, Coronary Heart Disease and Sinus Rhythm: Risk Prediction Score Analysis From the COMMANDER-HF Trial. J. Card. Fail. 2024. 30. (4):p. 618-623. IF:6,000. (1).
