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Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial.

Publication ,  Journal Article
White, HD; Steg, PG; Szarek, M; Bhatt, DL; Bittner, VA; Diaz, R; Edelberg, JM; Erglis, A; Goodman, SG; Hanotin, C; Harrington, RA; Jukema, JW ...
Published in: Eur Heart J
September 1, 2019

AIMS: The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin-kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. METHODS AND RESULTS: Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77-0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77-0.99; P = 0.032) and Type 2 (0.77, 0.61-0.97; P = 0.025), but not Type 4 MI. CONCLUSION: After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

September 1, 2019

Volume

40

Issue

33

Start / End Page

2801 / 2809

Location

England

Related Subject Headings

  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Double-Blind Method
  • Cholesterol, LDL
  • Cardiovascular System & Hematology
  • Antibodies, Monoclonal, Humanized
 

Citation

APA
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White, H. D., Steg, P. G., Szarek, M., Bhatt, D. L., Bittner, V. A., Diaz, R., … ODYSSEY OUTCOMES Investigators, . (2019). Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial. Eur Heart J, 40(33), 2801–2809. https://doi.org/10.1093/eurheartj/ehz299
White, Harvey D., Ph Gabriel Steg, Michael Szarek, Deepak L. Bhatt, Vera A. Bittner, Rafael Diaz, Jay M. Edelberg, et al. “Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial.Eur Heart J 40, no. 33 (September 1, 2019): 2801–9. https://doi.org/10.1093/eurheartj/ehz299.
White HD, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial. Eur Heart J. 2019 Sep 1;40(33):2801–9.
White, Harvey D., et al. “Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial.Eur Heart J, vol. 40, no. 33, Sept. 2019, pp. 2801–09. Pubmed, doi:10.1093/eurheartj/ehz299.
White HD, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, Edelberg JM, Erglis A, Goodman SG, Hanotin C, Harrington RA, Jukema JW, Lopes RD, Mahaffey KW, Moryusef A, Pordy R, Roe MT, Sritara P, Tricoci P, Zeiher AM, Schwartz GG, ODYSSEY OUTCOMES Investigators. Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial. Eur Heart J. 2019 Sep 1;40(33):2801–2809.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

September 1, 2019

Volume

40

Issue

33

Start / End Page

2801 / 2809

Location

England

Related Subject Headings

  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Double-Blind Method
  • Cholesterol, LDL
  • Cardiovascular System & Hematology
  • Antibodies, Monoclonal, Humanized