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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • 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,

Published Date

  • April 19, 2022

Published In

Volume / Issue

  • 43 / 16

Start / End Page

  • 1554 - 1565

PubMed ID

  • 34922353

Pubmed Central ID

  • PMC9020985

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

Digital Object Identifier (DOI)

  • 10.1093/eurheartj/ehab804


  • eng

Conference Location

  • England