机构：[1]Green Lane Cardiovascular Services, Auckland City Hospital, 5 Park Road, Grafton, Auckland 1142, New Zealand[2]FACT (French Alliance for Cardiovascular Trials), an F-CRIN network, De´partement Hospitalo-Universitaire FIRE, AP-HP, Hoˆpital Bichat, Universite´ Paris-Diderot, Sorbonne Paris-Cite´, INSERM U-1148, 46 rue Henri Huchard, 75018 Paris, France[3]National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK[4]Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center School of Public Health, 450 Clarkson Avenue, Brooklyn, NY 11203, USA[5]Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA[6]Division of Cardiovascular Disease, University of Alabama at Birmingham, 701 19th Street South - LHRB 310, Birmingham, AL 35294, USA[7]Estudios Cardiolo´gicos Latinoame´rica, Instituto Cardiovascular de Rosario, Paraguay 160, Rosario, Santa Fe, Argentina[8]Sanofi, 55 Corporate Drive, Bridgewater, 08807 NJ, USA[9]Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu Street 13, LV1002, Riga, Latvia[10]Canadian VIGOUR Centre, 2-132 Li Ka Shing Centre for Health Research Innovation University of Alberta, Edmonton, Alberta, Canada T6G 2E1[11]St. Michael’s Hospital, 30 Bond Street, University of Toronto, Toronto, ON M5B 1W8, Canada[12]Sanofi, 54-56 Rue la Boe´tie, 75008 Paris, France[13]Stanford Center for Clinical Research, Department of Medicine, 300 Pasteur Drive, S-102, Stanford, CA 94305, USA[14]Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands[15]Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27710, USA[16]Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-102, Stanford, CA 94305, USA[17]Regeneron Pharmaceuticals, 777 Old Saw Mill River Road, Tarrytown, NY 10591, USA[18]Department of Medicine, Faculty of Medicine, Ramathibodi Hospital/Mahidol University, Rama VI Road 10400, Thailand[19]CSL Behring, 1100 N Miami Blvd Ste 613, Durham, NC 27703, USA[20]Department of Medicine III, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany[21]Division of Cardiology, University of Colorado School of Medicine, 1700 N. Wheeling Street, Aurora 80045, CO, USA
Aims The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin-kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (>= 1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77-0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77-0.99; P = 0.032) and Type 2 (0.77, 0.61-0.97; P = 0.025), but not Type 4 MI. Conclusion After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.
基金：
Supported by Sanofi and Regeneron Pharmaceuticals.
第一作者机构：[1]Green Lane Cardiovascular Services, Auckland City Hospital, 5 Park Road, Grafton, Auckland 1142, New Zealand
通讯作者：
推荐引用方式(GB/T 7714)：
Harvey D.White,Ph. Gabriel Steg,Michael Szarek,et al.Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial[J].EUROPEAN HEART JOURNAL.2019,40(33):2801-2809.doi:10.1093/eurheartj/ehz299.
APA：
Harvey D.White,Ph. Gabriel Steg,Michael Szarek,Deepak L. Bhatt,Vera A. Bittner...&Gregory G. Schwartz.(2019).Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial.EUROPEAN HEART JOURNAL,40,(33)
MLA：
Harvey D.White,et al."Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial".EUROPEAN HEART JOURNAL 40..33(2019):2801-2809
医学