Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/33968
Title: Effect of Alirocumab on Mortality After Acute Coronary Syndromes An Analysis of the ODYSSEY OUTCOMES Randomized Clinical Trial
Authors: STEG, Philippe GabrielSZAREK, MichaelBHATT, Deepak L.BITTNER, Vera A.BREGEAULT, Marie-FranceDALBY, Anthony J.DIAZ, RafaelEDELBERG, Jay M.GOODMAN, Shaun G.HANOTIN, CorinneHARRINGTON, Robert A.JUKEMA, J. WouterLECORPS, GuillaumeMAHAFFEY, Kenneth W.MORYUSEF, AngeleOSTADAL, PetrPARKHOMENKO, AlexanderPORDY, RobertROE, Matthew T.TRICOCI, PierluigiVOGEL, RobertWHITE, Harvey D.ZEIHER, Andreas M.SCHWARTZ, Gregory G.STEG, Ph. GabrielBHATT, Deepak L.BITTNER, Vera A.DIAZ, RafaelGOODMAN, Shaun G.HARRINGTON, Robert A.JUKEMA, J. WouterSZAREK, MichaelZEIHER, Andreas M.TRICOCI, PierluigiROE, Matthew T.MAHAFFEY, Kenneth W.EDELBERG, Jay M.HANOTIN, CorinneLECORPS, GuillaumeMORYUSEF, AngelePORDY, RobertSASIELA, William J.TAMBY, Jean-FrancoisAYLWARD, Philip E.DREXEL, HeinzSINNAEVE, PeterDILIC, MirzaGOTCHEVA, Nina N.GOODMAN, Shaun G.PRIETO, Juan-CarlosYONG, HuoLOPEZ-JARAMILLO, PatricioPECIN, IvanREINER, ZeljkoOSTADAL, PetrPOULSEN, Steen HvitfeldtVIIGIMAA, MargusNIEMINEN, Markku S.DANCHIN, NicolasCHUMBURIDZE, VakhtangMARX, NikolausLIBEROPOULOS, EvangelosVALDOVINOS, Pablo Carlos MontenegroTSE, Hung-FatKISS, Robert GaborXAVIER, DenisZAHGER, DoronVALGIMIGLI, MarcoKIMURA, TakeshiKIM, Hyo SooKIM, Sang-HyunKEDEV, SaskoERGLIS, AndrejsLAUCEVICIUS, AleksandrasYUSOFF, KhalidLOPEZ, RamosLOPEZ, Gabriel Arturo RamosALINGS, MarcoHALVORSEN, SigrunFLORES, Roger M. CorreaSY, Rody G.BUDAJ, AndrzejMORAIS, JoaoDOROBANTU, MariaKARPOV, YuriRISTIC, Arsen D.CHUA, TerranceMURIN, JanFRAS, ZlatkoDALBY, Anthony J.TUNON, JoseSILVA, H. Asita deHAGSTROM, EmilMULLER, ChristianCHIANG, Chern-EnSRITARA, PiyamitrGUNERI, SemaPARKHOMENKO, AlexanderRAY, Kausik K.MORIARTY, Patrick M.ROE, Matthew T.CHAITMAN, BernardKELSEY, Sheryl F.OLSSON, Anders G.ROULEAU, Jean-LucienSIMOONS, Maarten L.ALEXANDER, KarenMELONI, ChiaraROSENSON, RobertSIJBRANDS, Eric J. G.ALEXANDER, John H.ARMAGANIJAN, LucianaBAGAI, AkshayBAHIT, Maria CeciliaBRENNAN, J. MatthewCLIFTON, ShaunDEVORE, Adam D.DELOATCH, ShalondaDICKEY, SheilaDOMBROWSKI, KeithDUCROCQ, GregoryEAPEN, ZubinENDSLEY, PatriciaEPPINGER, ArleenHARRISON, Robert W.HESS, Connie NgHLATKY, Mark A.JORDAN, Joseph DedrickKNOWLES, Joshua W.KOLLS, Bradley J.KONG, David F.LEONARDI, SergioLILLIS, LindaMARON, David J.MARCUS, JillMATHEWS, RobinMEHTA, Rajendra H.MENTZ, Robert J.MOREIRA, Humberto GranerPATEL, Chetan B.PEREIRA, Sabrina BernardezPERKINS, LynnPOVSIC, Thomas J.PUYMIRAT, EtienneJONES, William SchuylerSHAH, Bimal R.SHERWOOD, Matthew W.STRINGFELLOW, KenyaSUJJAVANICH, DarinTOMA, MustafaDIEPEN, Sean F. P. VanWILSON, Matthew D.YAN, Andrew Tze-KayLOPES, Renato D.TROTTER, CharleneSCHIAVI, Lilia B.GARRIDO, MarceloALVARISQUETA, Andres F.SASSONE, Sonia A.BORDONAVA, Anselmo P.LIMA, Alberto E. Alves DeSCHMIDBERG, Jorge M.DURONTO, Ernesto A.CARUSO, Orlando C.NOVARETTO, Leonardo P.HOMINAL, Miguel AngelMONTANA, Oscar R.CACCAVO, AlbertoVILAMAJO, Oscar A. GomezLORENZATTI, Alberto J.CARTASEGNA, Luis R.PATERLINI, Gustavo A.MACKINNON, Ignacio J.CAIME, Guillermo D.AMUCHASTEGUI, MarcosSALOMONE, RodolfoCODUTTI, Oscar R.JURE, Horacio O.BONO, Julio O. E.HRABAR, Adrian D.VALLEJOS, Julio A.GUERRERO, Rodolfo A. AhuadNOVOA, FedericoPATOCCHI, Cristian A.ZAIDMAN, Cesar J.GIULIANO, Maria E.DRAN, Ricardo D.VICO, Marisa L.CARNERO, Gabriela S.GUZMAN, Pablo N.ALLENDE, Juan C. MedranoBRASCA, Daniela F. GarciaLABARTA, Miguel H. BustamanteNANI, SebastianBLUMBERG, Eduardo D. S.COLOMBO, Hugo R.LIBERMAN, AlbertoLUCIARDI, Hector L.WAISMAN, Gabriel D.BERLI, Mario A.DURAN, Ruben O. GarciaCESTARI, Horacio G.LUQUEZ, Hugo A.GIORDANO, Jorge A.SAAVEDRA, Silvia S.ZAPATA, GerardoCOSTAMAGNA, OsvaldoLLOIS, SusanaWAITES, Jonathon H.COLLINS, NicholasSOWARD, AllanAYLWARD, Philip E.HII, Chris L. S.SHAW, JamesARSTALL, Margaret A.HOROWITZ, JohnROGERS, James F.COLQUHOUN, DavidFLORES, Romulo E. 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Citation: CIRCULATION, v.140, n.2, p.103-112, 2019
Abstract: Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for >= 3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C >= 100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; P-interaction=0.007). In the alirocumab group, all-cause death declined with achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for >= 3 years, if baseline LDL-C is >= 100 mg/dL, or if achieved LDL-C is low.
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Artigos e Materiais de Revistas Científicas - FM/MCP
Departamento de Cardio-Pneumologia - FM/MCP

Artigos e Materiais de Revistas Científicas - HC/InCor
Instituto do Coração - HC/InCor

Artigos e Materiais de Revistas Científicas - LIM/11
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação


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