Sherwood MW, et al. - In this study, the risk for recurrent cardiovascular events post-acute coronary syndromes (ACS) was assessed among participants from the APPRAISE-2 trial, stratified by the presence or absence of prior stroke. Furthermore, interactions between prior stroke, treatment assignment (apixaban vs. placebo), and outcomes were tested. Post-ACS, a higher risk for recurrent cardiovascular events was observed in patients with prior stroke. Furthermore, they exhibited a differential risk/benefit profile with oral anticoagulation.

Methods

• Researchers studied 7391 patients with ACS from APPRAISE-2, stratified by the presence or absence of prior stroke.
• They compared baseline characteristics and outcomes of cardiovascular death, myocardial infarction (MI), or stroke between groups.
• Additionally, before and after multivariable adjustment with Cox proportional hazards models, interactions between prior stroke, treatment assignment (apixaban vs. placebo), and outcomes were tested.

Results

• Prior stroke was reported in 902 patients (12%).
• Researchers observed that in comparison with patients without prior stroke, those with prior stroke were older (69 vs. 67 years), had more hypertension (91% vs. 77%), peripheral vascular disease (22% vs.18%), and impaired renal function (38% vs. 30%) but less diabetes (44% vs. 48%).
• Data also demonstrated that patients with prior stroke vs. no prior stroke had higher unadjusted rates of cardiovascular death (4.8% vs. 4.0%), MI (11.2% vs. 7.1%), and ischemic stroke (3.2% vs. 0.9%).
• Similar rates of the composite of cardiovascular death, MI, or stroke were observed in patients with prior stroke assigned to apixaban, compared with those assigned to placebo (HR 1.39; 95% CI 0.92–2.08).
• Also, it was noted that patients without prior stroke assigned to apixaban had similar rates of cardiovascular death, MI, or ischemic stroke compared with those assigned to placebo (HR 0.87; 95% CI 0.73–1.04; p-interaction = 0.041).
• Median follow-up was 240 days.