Abstract 23086: Impact of Rivaroxaban Alone or in Combination With Aspirin versus Aspirin in Preventing Graft Occlusion in Patients With CABG Surgery COMPASS CABG

Background: Coronary artery bypass grafting (CABG) surgery reduces mortality in patients with severe ischemic heart disease. Patients with recent CABG surgery are at risk for early graft failure which is associated with an increased risk of myocardial infarction (MI) and death. Aspirin reduces the risk of graft failure and major adverse cardiovascular events (MACE) in patients with CABG, but is only modestly effective. We hypothesized that in patients with recent CABG surgery, rivaroxaban in combination with aspirin or rivaroxaban alone would be more effective than aspirin alone for the prevention of bypass graft failure. Methods: COMPASS CABG was designed to evaluate whether rivaroxaban 2.5mg twice-daily in combination with aspirin 100mg daily or rivaroxaban 5mg twice-daily is superior to aspirin 100mg daily for prevention of bypass graft failure and vascular events in patients with recent CABG surgery. The primary outcome was graft failure and the secondary outcome was a composite of MI, stroke, or CV death. Graft patency was assessed with a CT angiogram at 1 year after surgery. Results: Between March 2013 and May 2016, the COMPASS trial randomized 27,395 patients from 602 centers in 33 countries. Of these patients, 1,488 were randomized within 4-14 days after CABG surgery. Elective CABG was performed in 78.4% of these patients. Triple vessel disease was present in 77.8% of patients, double vessel disease in 17.1% and 24.1% of patients had a left main disease. The IMA was harvested as a pedicle in 70.9% of patients and with a skeletonized technique in 29.1%. Vein grafts were harvested in an open fashion in 87.8% of patients and with a minimally invasive approach in 12.2% of patients. Conclusion: The results of COMPASS CABG will be presented on the efficacy and safety of rivaroxaban, alone or in combination with aspirin on graft patency and MACE in the long-term management of patients with recent CABG surgery.