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Effects of alirocumab on types of myocardial infarction: Insights from the ODYSSEY OUTCOMES trial
Green Lane Cardiovascular Services, Auckland City Hospital, 5 Park Road, Grafton, Auckland, 1142, New Zealand.
FACT (French Alliance for Cardiovascular Trials), F-CRIN network, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université Paris-Diderot, Sorbonne Paris-Cité, INSERM U-1148, 46 rue Henri Huchard, Paris, 75018, France; National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.
Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center School of Public Health, 450 Clarkson Avenue, Brooklyn, NY 11203, United States.
Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
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2019 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 33, p. 2801-2809Article in journal (Refereed) Published
Abstract [en]

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. © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.

Place, publisher, year, edition, pages
Oxford University Press , 2019. Vol. 40, no 33, p. 2801-2809
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-162037DOI: 10.1093/eurheartj/ehz299ISI: 000490154300015PubMedID: 31121022Scopus ID: 2-s2.0-85070265173OAI: oai:DiVA.org:liu-162037DiVA, id: diva2:1370946
Available from: 2019-11-18 Created: 2019-11-18 Last updated: 2019-11-19

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Olsson, Anders

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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Endocrinology
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