Alirocumab Paired with Statin Reduces Risk for CABG Patients

In patients with a coronary artery bypass graft (CABG) procedure prior to an acute coronary syndrome, alirocumab added to a statin was associated with significantly reduced events and mortality, according to a new analysis.

The primary ODYSSEY OUTCOMES results were presented last year, with the present analysis published in the Journal of the American College of Cardiology. The study included 18,924 patients who were between one month and one year post-acute coronary syndrome. Patients had an elevated atherogenic lipoprotein level despite high-intensity background statin therapy. They were randomized to either alirocumab or to placebo subcutaneously every two weeks. The primary composite study endpoint was major adverse cardiovascular events (MACE), comprised of coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or unstable angina requiring hospitalization. The authors also categorized the patients by CABG status (no CABG, n=16,896; index CABG after qualifying acute coronary syndrome prior to randomization, n=1,025; or CABG before qulifying acute coronary syndrome, n=1,003). Media follow-up was 2.8 years.

According to the results, hazard ratios (all 95% confidence intervals) for MACE (no CABG=0.86 [0.78 to 0.95]; index CABG=0.85 [0.54 to 1.35]; prior CABG=0.77 [0.61 to 0.98]) and death (0.88 [0.75 to 1.03]; 0.85 [0.46 to 1.59]; 0.67 [0.44 to 1.01], respectively) were “consistent with the overall trial results,” according to the researchers. Absolute risk differed across CABG categories.

“Among patients with recent ACS and elevated atherogenic lipoproteins despite intensive statin therapy, alirocumab was associated with large absolute reductions in MACE and death in those with CABG preceding the acute coronary syndrome event,” the authors concluded.