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Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736383/ https://www.ncbi.nlm.nih.gov/pubmed/31121022 http://dx.doi.org/10.1093/eurheartj/ehz299 |
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author | White, Harvey D Steg, Ph Gabriel Szarek, Michael Bhatt, Deepak L Bittner, Vera A Diaz, Rafael Edelberg, Jay M Erglis, Andrejs Goodman, Shaun G Hanotin, Corinne Harrington, Robert A Jukema, J Wouter Lopes, Renato D Mahaffey, Kenneth W Moryusef, Angele Pordy, Robert Roe, Matthew T Sritara, Piyamitr Tricoci, Pierluigi Zeiher, Andreas M Schwartz, Gregory G |
author_facet | White, Harvey D Steg, Ph Gabriel Szarek, Michael Bhatt, Deepak L Bittner, Vera A Diaz, Rafael Edelberg, Jay M Erglis, Andrejs Goodman, Shaun G Hanotin, Corinne Harrington, Robert A Jukema, J Wouter Lopes, Renato D Mahaffey, Kenneth W Moryusef, Angele Pordy, Robert Roe, Matthew T Sritara, Piyamitr Tricoci, Pierluigi Zeiher, Andreas M Schwartz, Gregory G |
author_sort | White, Harvey D |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6736383 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-67363832019-09-16 Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial White, Harvey D Steg, Ph Gabriel Szarek, Michael Bhatt, Deepak L Bittner, Vera A Diaz, Rafael Edelberg, Jay M Erglis, Andrejs Goodman, Shaun G Hanotin, Corinne Harrington, Robert A Jukema, J Wouter Lopes, Renato D Mahaffey, Kenneth W Moryusef, Angele Pordy, Robert Roe, Matthew T Sritara, Piyamitr Tricoci, Pierluigi Zeiher, Andreas M Schwartz, Gregory G Eur Heart J Fast Track Clinical Research 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. Oxford University Press 2019-09-01 2019-05-23 /pmc/articles/PMC6736383/ /pubmed/31121022 http://dx.doi.org/10.1093/eurheartj/ehz299 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Fast Track Clinical Research White, Harvey D Steg, Ph Gabriel Szarek, Michael Bhatt, Deepak L Bittner, Vera A Diaz, Rafael Edelberg, Jay M Erglis, Andrejs Goodman, Shaun G Hanotin, Corinne Harrington, Robert A Jukema, J Wouter Lopes, Renato D Mahaffey, Kenneth W Moryusef, Angele Pordy, Robert Roe, Matthew T Sritara, Piyamitr Tricoci, Pierluigi Zeiher, Andreas M Schwartz, Gregory G Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial |
title | Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial |
title_full | Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial |
title_fullStr | Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial |
title_full_unstemmed | Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial |
title_short | Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial |
title_sort | effects of alirocumab on types of myocardial infarction: insights from the odyssey outcomes trial |
topic | Fast Track Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736383/ https://www.ncbi.nlm.nih.gov/pubmed/31121022 http://dx.doi.org/10.1093/eurheartj/ehz299 |
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