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

Abstract

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.

• Authors: Harvey D White, Gregory G Schwartz, Michael Szarek, Deepak L Bhatt, Vera A Bittner, Chern-En Chiang, Rafael Diaz, Shaun G Goodman, Johan Wouter Jukema, Megan Loy, Neha Pagidipati, Robert Pordy, Arsen D Ristić, Andreas M Zeiher, Daniel M Wojdyla, Philippe Gabriel Steg, ODYSSEY OUTCOMES Investigators
• Journal: European heart journal (Eur Heart J) Vol. 43 Issue 16 Pg. 1554-1565 (04 19 2022) ISSN: 1522-9645 [Electronic] England
• PMID: 34922353 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Chemical References

• Antibodies, Monoclonal, Humanized
• Anticholesteremic Agents
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• PCSK9 protein, human
• Proprotein Convertase 9
• alirocumab

Topics

• Acute Coronary Syndrome (chemically induced, complications, drug therapy)
• Antibodies, Monoclonal, Humanized
• Anticholesteremic Agents (therapeutic use)
• Heart Failure (chemically induced, complications, drug therapy)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Proprotein Convertase 9 (therapeutic use)
• Treatment Outcome