title: Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial.
abstract: OBJECTIVE
  We investigated the prevalence of prior myocardial infarction (MI) and incidence of ischaemic cardiovascular (CV) events among atrial fibrillation (AF) patients.
  
  
  RESULTS
  In ROCKET AF, 14 264 patients with nonvalvular AF were randomized to rivaroxaban or warfarin. The key efficacy outcome for these analyses was CV death, MI, and unstable angina (UA). This pre-specified analysis was performed on patients while on treatment. Rates are per 100 patient-years. Overall, 2468 (17%) patients had prior MI at enrollment. Compared with patients without prior MI, these patients were more likely to be male (75 vs. 57%), on aspirin at baseline (47 vs. 34%), have prior congestive heart failure (78 vs. 59%), diabetes (47 vs. 39%), hypertension (94 vs. 90%), higher mean CHADS2 score (3.64 vs. 3.43), and fewer prior strokes or transient ischaemic attacks (46 vs. 54%). CV death, MI, or UA rates tended to be lower in patients assigned rivaroxaban compared with warfarin [2.70 vs. 3.15; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.73-1.00; P = 0.0509]. CV death, MI, or UA rates were higher in those with prior MI compared with no prior MI (6.68 vs. 2.19; HR 3.04, 95% CI 2.59-3.56) with consistent results for CV death, MI, or UA for rivaroxaban compared with warfarin in prior MI compared with no prior MI (P interaction = 0.10).
  
  
  CONCLUSIONS
  Prior MI was common and associated with substantial risk for subsequent cardiac events. Patients with prior MI assigned rivaroxaban compared with warfarin had a non-significant 14% reduction of ischaemic cardiac events.
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Nessel
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D000077144:Clopidogrel; D004311:Double-Blind Method; D004617:Embolism / Q000517:prevention & control; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009025:Morpholines / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D000069552:Rivaroxaban; D020521:Stroke / Q000517:prevention & control; D013876:Thiophenes / Q000008:administration & dosage*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D013876:Thiophenes; C446540:thienopyridine; D014859:Warfarin; D000069552:Rivaroxaban; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Atrial fibrillation; Coronary artery disease; Factor Xa; Myocardial infarction; Outcomes; Rivaroxaban; Warfarin