Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome

Detalhes bibliográficos
Autor(a) principal: Steg, P. Gabriel
Data de Publicação: 2023
Outros Autores: Szarek, Michael, Valgimigli, Marco, Islam, Shahidul, Zeiher, Andreas M., Bhatt, Deepak L., Bittner, Vera A., Chiang, Chern-En, Diaz, Rafael, Goodman, Shaun G., Gotcheva, Nina, Harrington, Robert A., Jukema, J. Wouter, Kim, Hyo-Soo, Kim, Sang-Hyun, Morais, João, Pordy, Robert, Scemama, Michel, White, Harvey D., Schwartz, Gregory G., Steg, Ph. Gabriel
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.8/9213
Resumo: Funding Sources The ODYSSEY OUTCOMES trial was supported by Sanofi and Regeneron Pharmaceuticals.
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spelling Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary SyndromeAcute coronary syndromeHigher lipoprotein(a)AlirocumabTreatmentFunding Sources The ODYSSEY OUTCOMES trial was supported by Sanofi and Regeneron Pharmaceuticals.Background Many patients require revascularization after index acute coronary syndrome (ACS). Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In ODYSSEY OUTCOMES, alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a) levels. We explored whether risk of revascularization after ACS was modified by the level of lipoprotein(a) and treatment with alirocumab or placebo. Methods In ODYSSEY OUTCOMES alirocumab was compared with placebo in 18,924 patients with ACS and elevated atherogenic lipoprotein levels despite optimized statin treatment. In this post hoc analysis, treatment effects are summarized using competing risks proportional hazard models. Results A total of 1559 (8.2%) patients had coronary, 204 (1.1%) had limb, and 40 (0.2%) had carotid revascularization. Alirocumab reduced coronary revascularization (2.8 vs 3.2 events per 100 patient-years; hazard ratio [HR], 0.88 [95% confidence interval (CI), 0.80-0.97]; P = 0.01) and any revascularization (3.2 vs 3.7 events per 100 patient-years; HR, 0.85 [95% CI, 0.78-0.94]; P = 0.001). Baseline lipoprotein(a) quartile was directly associated with risk of coronary or any revascularization in the placebo arm and inversely related to treatment HRs (all P for trend < 0.01). Alirocumab produced the greatest reduction of coronary revascularization in patients with baseline lipoprotein(a) in the top quartile (≥ 59.6 mg/dL; HR, 0.69 [95% CI, 0.57-0.84]), but no apparent reduction in the bottom quartile (HR, 1.00 [95% CI, 0.82-1.22]). Findings were similar for the effect of alirocumab on any revascularization. Conclusions Alirocumab reduced revascularization rates after ACS. The risk of revascularization and reduction in that risk with alirocumab were greatest in patients with elevated lipoprotein(a) at baseline.Résumé Contexte De nombreux patients ont besoin d’une revascularisation après un premier syndrome coronarien aigu (SCA), et la lipoprotéine A jouerait un rôle dans la pathogenèse de l’athérothrombose. Dans l’étude ODYSSEY OUTCOMES, l’alirocumab a permis de réduire la survenue d’événements cardiovasculaires indésirables majeurs après un SCA, et cette réduction a été plus importante chez les personnes dont le taux de lipoprotéine A était plus élevé. Nous avons cherché à savoir si le risque de revascularisation après un SCA variait en fonction du taux de lipoprotéine A et de l’administration d’alirocumab ou d’un placebo. Méthodologie Dans l’étude ODYSSEY OUTCOMES, l’alirocumab a été comparé à un placebo chez 18 924 patients ayant subi un SCA et présentant un taux élevé de lipoprotéines athérogènes malgré un traitement par statine optimisé. Dans cette analyse a posteriori, les effets du traitement sont résumés à l’aide de modèles à risques proportionnels concurrents. Résultats Un total de 1 559 patients (8,2 %) ont subi une revascularisation coronarienne, 204 (1,1 %) ont subi la revascularisation d’un membre et 40 (0,2 %) ont subi une revascularisation carotidienne. L’alirocumab a permis de réduire le taux de revascularisation coronarienne (2,8 contre 3,2 événements pour 100 années-patients; rapport des risques instantanés [RRI] : 0,88 [intervalle de confiance (IC) à 95 % : 0,80-0,97]; P = 0,01) et celui des autres types de revascularisation (3,2 contre 3,7 événements pour 100 années-patients; RRI : 0,85 [IC à 95 % : 0,78-0,94]; P = 0,001). Le quartile de distribution du taux de lipoprotéine A à l’inclusion était directement associé au risque de revascularisation coronarienne ou d’un autre type de revascularisation dans le groupe placebo et inversement lié au RRI du traitement (tendance pour toutes les valeurs de P < 0,01). L’alirocumab a entraîné la plus grande réduction du taux de revascularisation coronarienne lorsque le taux initial de lipoprotéine A se situait dans le quartile supérieur (≥ 59,6 mg/dl; RRI : 0,69 [IC à 95 % : 0,57-0,84]), mais aucune réduction apparente lorsqu’il se situait dans le quartile inférieur (RRI : 1,00 [IC à 95 % : 0,82-1,22]). Les effets du traitement par l’alirocumab ont été similaires indépendamment du type de revascularisation. Conclusions L’alirocumab a réduit les taux de revascularisation après un SCA. Le risque de revascularisation et la réduction de ce risque avec l’alirocumab étaient les plus élevés chez les patients ayant un taux de lipoprotéine A élevé au départ.ElsevierIC-OnlineSteg, P. GabrielSzarek, MichaelValgimigli, MarcoIslam, ShahidulZeiher, Andreas M.Bhatt, Deepak L.Bittner, Vera A.Chiang, Chern-EnDiaz, RafaelGoodman, Shaun G.Gotcheva, NinaHarrington, Robert A.Jukema, J. WouterKim, Hyo-SooKim, Sang-HyunMorais, JoãoPordy, RobertScemama, MichelWhite, Harvey D.Schwartz, Gregory G.Steg, Ph. Gabriel2024-01-09T14:55:59Z2023-04-262023-04-26T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.8/9213engSteg, P. G., Szarek, M., Valgimigli, M., Islam, S., Zeiher, A. M., Bhatt, D. L., ... & Steg, P. G. (2023). Lipoprotein (a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome. Canadian journal of cardiology, 39(10), 1315-1324.0828-282Xhttps://doi.org/10.1016/j.cjca.2023.04.0181916-7075info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-01-17T15:58:52Zoai:iconline.ipleiria.pt:10400.8/9213Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T01:51:41.888792Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
title Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
spellingShingle Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
Steg, P. Gabriel
Acute coronary syndrome
Higher lipoprotein(a)
Alirocumab
Treatment
title_short Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
title_full Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
title_fullStr Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
title_full_unstemmed Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
title_sort Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome
author Steg, P. Gabriel
author_facet Steg, P. Gabriel
Szarek, Michael
Valgimigli, Marco
Islam, Shahidul
Zeiher, Andreas M.
Bhatt, Deepak L.
Bittner, Vera A.
Chiang, Chern-En
Diaz, Rafael
Goodman, Shaun G.
Gotcheva, Nina
Harrington, Robert A.
Jukema, J. Wouter
Kim, Hyo-Soo
Kim, Sang-Hyun
Morais, João
Pordy, Robert
Scemama, Michel
White, Harvey D.
Schwartz, Gregory G.
Steg, Ph. Gabriel
author_role author
author2 Szarek, Michael
Valgimigli, Marco
Islam, Shahidul
Zeiher, Andreas M.
Bhatt, Deepak L.
Bittner, Vera A.
Chiang, Chern-En
Diaz, Rafael
Goodman, Shaun G.
Gotcheva, Nina
Harrington, Robert A.
Jukema, J. Wouter
Kim, Hyo-Soo
Kim, Sang-Hyun
Morais, João
Pordy, Robert
Scemama, Michel
White, Harvey D.
Schwartz, Gregory G.
Steg, Ph. Gabriel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv IC-Online
dc.contributor.author.fl_str_mv Steg, P. Gabriel
Szarek, Michael
Valgimigli, Marco
Islam, Shahidul
Zeiher, Andreas M.
Bhatt, Deepak L.
Bittner, Vera A.
Chiang, Chern-En
Diaz, Rafael
Goodman, Shaun G.
Gotcheva, Nina
Harrington, Robert A.
Jukema, J. Wouter
Kim, Hyo-Soo
Kim, Sang-Hyun
Morais, João
Pordy, Robert
Scemama, Michel
White, Harvey D.
Schwartz, Gregory G.
Steg, Ph. Gabriel
dc.subject.por.fl_str_mv Acute coronary syndrome
Higher lipoprotein(a)
Alirocumab
Treatment
topic Acute coronary syndrome
Higher lipoprotein(a)
Alirocumab
Treatment
description Funding Sources The ODYSSEY OUTCOMES trial was supported by Sanofi and Regeneron Pharmaceuticals.
publishDate 2023
dc.date.none.fl_str_mv 2023-04-26
2023-04-26T00:00:00Z
2024-01-09T14:55:59Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.8/9213
url http://hdl.handle.net/10400.8/9213
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Steg, P. G., Szarek, M., Valgimigli, M., Islam, S., Zeiher, A. M., Bhatt, D. L., ... & Steg, P. G. (2023). Lipoprotein (a) and the Effect of Alirocumab on Revascularization After Acute Coronary Syndrome. Canadian journal of cardiology, 39(10), 1315-1324.
0828-282X
https://doi.org/10.1016/j.cjca.2023.04.018
1916-7075
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
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