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Alirocumab after acute coronary syndrome in patients with a history of heart failure.

Publication ,  Journal Article
White, HD; Schwartz, GG; Szarek, M; Bhatt, DL; Bittner, VA; Chiang, C-E; Diaz, R; Goodman, SG; Jukema, JW; Loy, M; Pagidipati, N; Pordy, R ...
Published in: Eur Heart J
April 19, 2022

AIMS: Patients with heart failure (HF) have not been shown to benefit from statins. In a post hoc analysis, we evaluated outcomes in ODYSSEY OUTCOMES in patients with vs. without a history of HF randomized to the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab or placebo. METHODS AND RESULTS: Among 18 924 patients with recent acute coronary syndrome (ACS) receiving intensive or maximum-tolerated statin treatment, the primary outcome of major adverse cardiovascular events (MACE) was compared in patients with or without a history of HF. The pre-specified secondary outcome of hospitalization for HF was also analysed. Overall, 2815 (14.9%) patients had a history of HF. Alirocumab reduced low-density lipoprotein cholesterol and lipoprotein(a) similarly in patients with or without HF. Overall, alirocumab reduced MACE compared with placebo [hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.78-0.93; P = 0.0001]. This effect was observed among patients without a history of HF (HR: 0.78; 95% CI: 0.70-0.86; P < 0.0001), but not in those with a history of HF (HR: 1.17; 95% CI: 0.97-1.40; P = 0.10) (Pinteraction = 0.0001). Alirocumab did not reduce hospitalization for HF, overall or in patients with or without prior HF. CONCLUSION: Alirocumab reduced MACE in patients without a history of HF but not in patients with a history of HF. Alirocumab did not reduce hospitalizations for HF in either group. Patients with a history of HF are a high-risk group that does not appear to benefit from PCSK9 inhibition after ACS.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

April 19, 2022

Volume

43

Issue

16

Start / End Page

1554 / 1565

Location

England

Related Subject Headings

  • Treatment Outcome
  • Proprotein Convertase 9
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Heart Failure
  • Cardiovascular System & Hematology
  • Anticholesteremic Agents
  • Antibodies, Monoclonal, Humanized
  • Acute Coronary Syndrome
  • 3202 Clinical sciences
 

Citation

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White, H. D., Schwartz, G. G., Szarek, M., Bhatt, D. L., Bittner, V. A., Chiang, C.-E., … ODYSSEY OUTCOMES Investigators, . (2022). Alirocumab after acute coronary syndrome in patients with a history of heart failure. Eur Heart J, 43(16), 1554–1565. https://doi.org/10.1093/eurheartj/ehab804
White, Harvey D., Gregory G. Schwartz, Michael Szarek, Deepak L. Bhatt, Vera A. Bittner, Chern-En Chiang, Rafael Diaz, et al. “Alirocumab after acute coronary syndrome in patients with a history of heart failure.Eur Heart J 43, no. 16 (April 19, 2022): 1554–65. https://doi.org/10.1093/eurheartj/ehab804.
White HD, Schwartz GG, Szarek M, Bhatt DL, Bittner VA, Chiang C-E, et al. Alirocumab after acute coronary syndrome in patients with a history of heart failure. Eur Heart J. 2022 Apr 19;43(16):1554–65.
White, Harvey D., et al. “Alirocumab after acute coronary syndrome in patients with a history of heart failure.Eur Heart J, vol. 43, no. 16, Apr. 2022, pp. 1554–65. Pubmed, doi:10.1093/eurheartj/ehab804.
White HD, Schwartz GG, Szarek M, Bhatt DL, Bittner VA, Chiang C-E, Diaz R, Goodman SG, Jukema JW, Loy M, Pagidipati N, Pordy R, Ristić AD, Zeiher AM, Wojdyla DM, Steg PG, ODYSSEY OUTCOMES Investigators. Alirocumab after acute coronary syndrome in patients with a history of heart failure. Eur Heart J. 2022 Apr 19;43(16):1554–1565.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

April 19, 2022

Volume

43

Issue

16

Start / End Page

1554 / 1565

Location

England

Related Subject Headings

  • Treatment Outcome
  • Proprotein Convertase 9
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Heart Failure
  • Cardiovascular System & Hematology
  • Anticholesteremic Agents
  • Antibodies, Monoclonal, Humanized
  • Acute Coronary Syndrome
  • 3202 Clinical sciences