Alirocumab and Cardiovascular Outcomes in Patients With Previous Myocardial Infarction: Prespecified Subanalysis From...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Patients with acute coronary syndrome (ACS) and a prior myocardial infarction (MI) are at elevated risk for major adverse cardiovascular events (MACE) and mortality.
• The ODYSSEY OUTCOMES trial investigated the efficacy of alirocumab, a PCSK9 inhibitor, in this high-risk population.

Purpose of the Study:

• To evaluate the effect of alirocumab on MACE and death in patients with recent ACS, specifically analyzing outcomes based on previous MI history.
• To determine if the benefits of alirocumab differ between patients with and without a history of MI.

Main Methods:

• The ODYSSEY OUTCOMES trial randomized 18,924 patients post-ACS to receive either alirocumab or placebo.
• Follow-up was conducted for a median of 2.8 years, with primary MACE outcomes including cardiovascular death, nonfatal MI, ischemic stroke, and unstable angina hospitalization.
• Subgroup analysis was performed based on the presence (19.2% of patients) or absence of a previous MI.

Main Results:

• Patients with previous MI were older, more male, and had higher cardiovascular risk factors and event history.
• With placebo, the 4-year risk of MACE was 20.5% in those with prior MI versus 8.9% without (P < 0.001).
• Alirocumab consistently reduced MACE and death risk in both groups (MACE aHR 0.90 vs. 0.82; Death aHR 0.84 vs. 0.87), with numerically greater absolute risk reductions for MACE (1.91% vs. 1.42%) and death (1.35% vs. 0.41%) in the prior MI subgroup.

Conclusions:

• A history of MI significantly increases the risk of recurrent MACE and death following ACS.
• Alirocumab demonstrates consistent relative risk reduction for these adverse events in ACS patients, irrespective of prior MI status.
• The absolute benefit of alirocumab was numerically greater in patients with a previous MI, highlighting its value in this high-risk group.