title: The effect of rivaroxaban on myocardial infarction in the ATLAS ACS 2 - TIMI 51 trial.
abstract: OBJECTIVE
  Rivaroxaban reduces cardiovascular death, myocardial infarction (MI), or stroke in patients following acute coronary syndrome (ACS). We aimed to characterize the specific effects of rivaroxaban on the size and type of MI.
  
  
  METHODS
  The Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 51 (ATLAS ACS 2-TIMI 51) study randomized 15,526 patients with a recent ACS to rivaroxaban 2.5 mg BID, rivaroxaban 5 mg BID, or placebo. An independent clinical events committee adjudicated each MI that occurred during the study and further classified them based on type. Data are presented as two-year Kaplan-Meier event rates and hazard ratios (HRs) and 95% confidence intervals (CI).
  
  
  RESULTS
  In total, 665 patients experienced a post-randomization MI. The majority (n=535, 80.5%) were spontaneous (Type 1) events. Rivaroxaban reduced spontaneous MI when compared with placebo (4.4% vs 5.7%, HR 0.80, 95% 0.67-0.95, p=0.01), and there were directionally consistent reductions with both the 2.5 mg BID (4.7% vs 5.7%, HR 0.84, 95% 0.68-1.02, p=0.08) and 5 mg BID doses (4.1% vs 5.7%, HR 0.77, 95% 0.62-0.94, p=0.01) as compared with placebo. Rivaroxaban reduced MI with large elevations in troponin or creatine kinase-MB (CK-MB) fraction (1.8% vs 2.4%, HR 0.73, 95% CI 0.56-0.96, p=0.03) and STEMI events (1.7% vs 2.5%, HR 0.74, 95% CI 0.56-0.99, p=0.04).
  
  
  CONCLUSIONS
  In patients stabilized and followed after ACS, the majority of MIs that occur are spontaneous and rivaroxaban significantly reduced the incidence of these events. Notably, rivaroxaban reduced MIs with extensive biomarker release and ST-segment elevation.
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Cavender
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA.
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA.
authors.forename: Eri
authors.initials: E
authors.lastname: Toda Kato
authors.affiliation: Janssen Research and Development, LLC, USA.
authors.forename: Alexei N
authors.initials: AN
authors.lastname: Plotnikov
authors.affiliation: Hospital Privado, Centro Médico de Córdoba, Argentina.
authors.forename: Marcos
authors.initials: M
authors.lastname: Amuchástegui
authors.affiliation: Department of Cardiology, Canisius Wilhelmina Ziekenhuis, The Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: Oude Ophuis
authors.affiliation: Department of Cardiology, Groene Hart Hospital, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Hessen
authors.affiliation: TIMI Study Group, Heart & Vascular Center, Brigham and Women's Hospital and Harvard Medical School, USA jmega@partners.org.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Mega
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D015415:Biomarkers / Q000378:metabolism; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D004334:Drug Administration Schedule; D065427:Factor Xa Inhibitors / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000517:prevention & control*; D000069552:Rivaroxaban / Q000008:administration & dosage*; D055502:Secondary Prevention; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D065427:Factor Xa Inhibitors; D014336:Troponin; D000069552:Rivaroxaban; D052279:Creatine Kinase, MB Form
keywords: Anti-thrombotic therapy; acute coronary syndrome; secondary prevention