Blood pressure and antithrombotic in atrial fibrillation and coronary disease

BackgroundsAtrial fibrillation (AF) is a risk factor for adverse cardiovascular outcomes in patients with stable coronary artery disease (CAD). The prognostic relevance of lower systolic blood pressure (SBP) and the optimal antithrombotic strategy in patients with AF and CAD remain to be clarified. MethodsThis post-hoc analysis of the AFIRE (Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease) trial stratified participants based on median SBP at baseline: >126 mmHg (High SBP group, n=1042) and [≤]126 mmHg (Low SBP group, n=1093). The primary efficacy endpoint was a composite of cardiovascular events and all-cause death. The primary safety endpoint was major bleeding. ResultsThe mean SBP was 139 mmHg and 114 mmHg in the High and Low SBP groups, respectively. In the propensity score-matched cohort (n=1684), the Low SBP group had a significantly higher incidence of the primary efficacy endpoint (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.01-1.88; p=0.039), while the primary safety endpoint was comparable between groups. In the Low SBP group, rivaroxaban monotherapy was associated with lower risks of both the primary efficacy (HR, 0.66; 95% CI, 0.41-0.86; p=0.006) and safety endpoints (HR, 0.40; 95% CI, 0.22-0.74; p=0.003) compared with combination therapy, whereas no significant differences were observed in the High SBP group. ConclusionsLower SBP was associated with increased risk of cardiovascular events and all-cause death. Rivaroxaban monotherapy demonstrated more favorable efficacy and safety outcomes compared with combination therapy, particularly among patients with lower SBP.