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Impact of Apolipoprotein A-I Infusions on Cardiovascular Events Post-MI by Neutrophil-Lymphocyte Ratio and

Sem A O F Rikken1, C Michael Gibson2, M Cecilia Bahit3

  • 1Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Baim Institute for Clinical Research, Boston, Massachusetts, USA.

JACC. Advances
|April 27, 2025
PubMed

Insights

Elevated neutrophil-lymphocyte ratio (NLR) predicts major adverse cardiovascular events (MACE) after acute myocardial infarction (AMI). CSL112 therapy reduced MACE in patients with high NLR and LDL-C.

Area of Science:

  • Cardiology
  • Inflammation Research
  • Pharmacology

Background:

  • The AEGIS-II trial investigated CSL112 (apolipoprotein A-I therapy) for cardiovascular event reduction post-acute myocardial infarction (AMI).
  • Exploratory analysis examined the influence of baseline neutrophil-lymphocyte ratio (NLR) and LDL-C on CSL112 efficacy, given CSL112's anti-inflammatory potential.

Purpose of the Study:

  • To assess the association between baseline NLR and cardiovascular events in post-AMI patients.
  • To determine if NLR and LDL-C modify the efficacy of CSL112 treatment.

Main Methods:

  • 18,219 AMI patients received 4 weekly infusions of CSL112 or placebo.
  • Primary endpoint: composite of cardiovascular death, myocardial infarction, or stroke (MACE).
  • Cox models analyzed risk by dichotomized NLR; treatment interactions with NLR and LDL-C were assessed.

Main Results:

  • Elevated baseline NLR (>median) was associated with a significantly higher risk of MACE at 90 days (HR: 1.40), persisting long-term.
  • CSL112 reduced MACE at 90 days in patients with elevated NLR and LDL-C ≥100 mg/dL (HR: 0.63), with sustained benefits.
  • Significant interactions were found between CSL112 treatment and NLR, and treatment, NLR, and LDL-C.

Conclusions:

  • Baseline elevated NLR is a predictor of MACE in post-AMI patients.
  • CSL112 demonstrated a reduction in MACE among patients with elevated NLR and elevated LDL-C (≥100 mg/dL).
Abstract

Keywords:
CSL112MACEapolipoprotein A-Iinflammationneutrophil-lymphocyte ratio

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