Abstract | BACKGROUND: METHODS AND RESULTS: The risk of a number of outcomes, including the composite of SSE or death (to take account of competing risks) and composite of SSE, major bleeding, or death (net clinical benefit) were calculated in 3 patient groups: (1) no HF/no LVSD (n=8728), (2) HF/no LVSD (n=3207), and (3) LVSD with/without symptomatic HF (n=2736). The rate of both outcomes was highest in patients with LVSD (SSE or death 8.06; SSE, major bleeding, or death 10.46 per 100 patient-years), intermediate for HF but preserved LV systolic function (5.32; 7.24), and lowest in patients without HF or LVSD (1.54; 5.27); each comparison P<0.0001. Each outcome was less frequent in patients treated with apixaban: in all ARISTOTLE patients, the apixaban/ warfarin hazard ratio for SSE or death was 0.89 (95% confidence interval, 0.81-0.98; P=0.02); for SSE, major bleed, or death it was 0.85 (0.78-0.92; P<0.001). There was no heterogeneity of treatment effect across the 3 groups. CONCLUSIONS: Patients with LVSD (with/without HF) had a higher risk of SSE or death (but similar rate of SSE) compared with patients with HF but preserved LV systolic function; both had a greater risk than patients without either HF or LVSD. Apixaban reduced the risk of both outcomes more than warfarin in all 3 patient groups. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
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Authors | John J V McMurray, Justin A Ezekowitz, Basil S Lewis, Bernard J Gersh, Sean van Diepen, John Amerena, Jozef Bartunek, Patrick Commerford, Byung-Hee Oh, Veli-Pekka Harjola, Sana M Al-Khatib, Michael Hanna, John H Alexander, Renato D Lopes, Daniel M Wojdyla, Lars Wallentin, Christopher B Granger, ARISTOTLE Committees and Investigators |
Journal | Circulation. Heart failure
(Circ Heart Fail)
Vol. 6
Issue 3
Pg. 451-60
(May 2013)
ISSN: 1941-3297 [Electronic] United States |
PMID | 23575255
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Pyrazoles
- Pyridones
- apixaban
- Warfarin
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Topics |
- Aged
- Anticoagulants
(therapeutic use)
- Atrial Fibrillation
(drug therapy, epidemiology)
- Comorbidity
- Embolism
(epidemiology, prevention & control)
- Female
- Heart Failure
(epidemiology, physiopathology)
- Humans
- Male
- Middle Aged
- Pyrazoles
(therapeutic use)
- Pyridones
(therapeutic use)
- Retrospective Studies
- Risk Assessment
- Stroke
(epidemiology)
- Ventricular Dysfunction, Left
(epidemiology)
- Warfarin
(therapeutic use)
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