5 research outputs found
Risk Categorization Using New American College of Cardiology/American Heart Association Guidelines for Cholesterol Management and Its Relation to Alirocumab Treatment Following Acute Coronary Syndromes
BACKGROUND: The 2018 US cholesterol management guidelines recommend
additional lipid-lowering therapies for secondary prevention in patients with lowdensity lipoprotein cholesterol ≥70 mg/dL or non−high-density lipoprotein cholesterol
≥100 mg/dL despite maximum tolerated statin therapy. Such patients are considered
at very high risk (VHR) based on a history of >1 major atherosclerotic cardiovascular
disease (ASCVD) event or a single ASCVD event and multiple high-risk conditions.
We investigated the association of US guideline-defined risk categories with the
occurrence of ischemic events after acute coronary syndrome and reduction of
those events by alirocumab, a PCSK9 (proprotein convertase subtilisin/kexin type 9)
inhibitor.
METHODS: In the ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular
Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab),
patients with recent acute coronary syndrome and residual dyslipidemia despite
optimal statin therapy were randomly assigned to alirocumab or placebo. The primary
trial outcome (major adverse cardiovascular events, ie, coronary heart disease death,
nonfatal myocardial infarction, is
Prasugrel versus clopidogrel in acute coronary syndrome patients undergoing percutaneous coronary intervention
Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease.The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators
BACKGROUND: A proportion of patients who present with suspected acute
coronary syndrome (ACS) are found to have insignificant coronary artery
disease (CAD) during coronary angiography, but these patients have not
been well characterized. METHODS AND RESULTS: Of the 5767 patients with
non-ST-segment elevation ACS who were enrolled in the Platelet
Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using
Integrilin (Eptifibatide) Therapy (PURSUIT) trial and who underwent
in-hospital angiography, 88% had significant CAD (any stenosis >50%), 6%
had mild CAD (any stenosis >0% to </=50%), and 6% had no CAD (no stenosis
identified). The frequency of death or nonfatal myocardial infarction at
30 days was reduced with eptifibatide treatment in patients with
significant CAD (18.3% versus 15.6% for placebo, P=0.006) but not in those
with mild CAD (6.6% versus 5.4%, P=0.62) and with no CAD (3.0% versus 1.
2%, P=0.28). We identified independent baseline predictors of
insignificant CAD (mild or no CAD) and used them to develop a simple
predictive nomogram of the probability of insignificant CAD for use at
hospital presentation. This nomogram was validated in a separate
population of patients with non-ST-segment elevation ACS. CONCLUSIONS:
Patients with suspected ACS found to have insignificant CAD have a low
risk of adverse outcomes, do not appear to benefit from treatment with
eptifibatide, and can be predicted with a simple nomogram drawn from
baseline characteristics. Because patients with significant CAD appear to
have an enhanced benefit from eptifibatide treatment, the predictive
nomogram developed can be used to determine indications for glycoprotein
IIb/IIIa blockade