Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background: The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial compared alirocumab with placebo, added to high-intensity or maximum-tolerated statin treatment, after acute coronary syndrome (ACS) in 18,924 patients. Alirocumab reduced the first occurrence of the primary composite endpoint and was associated with fewer all-cause deaths.
Objectives: This pre-specified analysis determined the extent to which alirocumab reduced total (first and subsequent) nonfatal cardiovascular events and all-cause deaths in ODYSSEY OUTCOMES.
Methods: Hazard functions for total nonfatal cardiovascular events (myocardial infarction, stroke, ischemia-driven coronary revascularization, and hospitalization for unstable angina or heart failure) and death were jointly estimated, linked by a shared frailty accounting for patient risk heterogeneity and correlated within-patient nonfatal events. An association parameter also quantified the strength of the linkage between risk of nonfatal events and death. The model provides accurate relative estimates of nonfatal event risk if nonfatal events are associated with increased risk for death.
Results: With 3,064 first and 5,425 total events, 190 fewer first and 385 fewer total nonfatal cardiovascular events or deaths were observed with alirocumab compared with placebo. Alirocumab reduced total nonfatal cardiovascular events (hazard ratio: 0.87; 95% confidence interval: 0.82 to 0.93) and death (hazard ratio: 0.83; 95% confidence interval: 0.71 to 0.97) in the presence of a strong association between nonfatal and fatal event risk.
Conclusions: In patients with ACS, the total number of nonfatal cardiovascular events and deaths prevented with alirocumab was twice the number of first events prevented. Consequently, total event reduction is a more comprehensive metric to capture the totality of alirocumab clinical efficacy after ACS.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jacc.2018.10.039 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Left Atrial Appendage Occlusion vs Anticoagulants in Dialysis With Atrial Fibrillation.
JAMA Netw Open
September 2025
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock.
Importance: Patients with kidney failure (KF) receiving long-term dialysis have increased incidence of atrial fibrillation (AF). Patients with KF and AF have increased risk of stroke, death, and bleeding compared with age-matched cohorts. In KF, the use of oral anticoagulants (OACs) increases hemorrhage risk, offsetting potential benefits and making left atrial appendage occlusion (LAAO) a potentially promising solution for risk reduction in AF.
View Article and Find Full Text PDFEffect of spironolactone on cardiovascular and renal outcomes in patients with chronic kidney disease.
Clin Kidney J
September 2025
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Background: Steroidal mineralocorticoid receptor antagonists (MRAs), including spironolactone, effectively treat resistant hypertension, reduce proteinuria and lower mortality in heart failure with reduced ejection fraction. However, their long-term effects in chronic kidney disease (CKD) remain unclear. This study investigated spironolactone's impact on end-stage renal disease (ESRD), major adverse cardiovascular events (MACE), hyperkalemia and mortality in CKD patients.
View Article and Find Full Text PDFThe long-term prognostic value of the framingham risk scoring in patients with myocardial infarction with nonobstructive coronary arteries.
Am J Prev Cardiol
September 2025
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, No. 167, North Lishi Road, Xicheng District, Beijing 100037, China.
Background: The Framingham Risk Score for Cardiovascular Disease (FRSCVD), based on the Framingham Heart Study, serves as a foundation for many prediction models. However, its applicability in predicting the long-term prognosis of patients experiencing myocardial infarction with nonobstructive coronary arteries (MINOCA) remains uncertain.
Methods: A cohort of 1158 MINOCA patients was enrolled and stratified into three groups based on 10-year FRSCVD risk.
Inducible Ischemia in Asymptomatic Patients With Coronary Chronic Total Occlusions: A Stress CMR Study.
Catheter Cardiovasc Interv
September 2025
IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
Background: Given the divergence in recommendations regarding the relevance of inducible ischemia regarding the indication to revascularize chronic total occlusions (CTOs) among European and North American guidelines, we aim at investigating the prevalence and the prognostic impact of significant inducible ischemia in an unselected cohort of asymptomatic CTO patients, integrating collateralization status and viability assessment with stress cardiac magnetic resonance (CMR).
Methods: From a cohort of 749 patients referred to our center with a diagnosis of CTO, we retrospectively analyzed 111 asymptomatic individuals who underwent an adenosine stress CMR. The amount of inducible ischemia subtended by the CTO was calculated, as well as the presence of viable myocardium and the collateralization status.
Comparison of Short- and Long-Term Cardiovascular Disease Risk Assessment Tools in US Young Adults.
J Am Heart Assoc
September 2025
Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA USA.
Background: In 2023, the American Heart Association published the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk in adults aged 30 to 79 years. We compared PREVENT's performance with existing US guideline recommended models-Pooled Cohort Equations for 10-year ASCVD risk and FHS (Framingham Heart Study) equations for 30-year ASCVD risk-among young adults.
Methods: We analyzed adults aged 20 to 39 years without baseline ASCVD from 2 sources: (1) pooled data from 2 large epidemiologic cohorts (CARDIA [Coronary Artery Risk Development in Young Adults] and FHS, n=7763), and (2) electronic health records from Kaiser Permanente Southern California (n=266 378).