Clinical Benefit of Evolocumab by Severity and Extent of Coronary Artery Disease: An Analysis from FOURIER
| Autor: | Basil S. Lewis, Gaetano M. De Ferrari, Kurt Huber, Terje R. Pedersen, Robert P. Giugliano, Anthony C Keech, Peter S. Sever, Narimon Honarpour, Jorge Ferreira, Stephen D. Wiviott, Christopher E. Kurtz, Julia F Kuder, Sabina A. Murphy, Marc S. Sabatine |
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| Přispěvatelé: | Amgen Inc |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
PCSK9 protein human Time Factors Cardiac & Cardiovascular Systems Cost effectiveness PROGRESSION Coronary Artery Disease SECONDARY PREVENTION 030204 cardiovascular system & hematology Severity of Illness Index THERAPY COST-EFFECTIVENESS PCSK9 Coronary artery disease 0302 clinical medicine Recurrence Risk Factors Cause of Death 030212 general & internal medicine Myocardial infarction Aged 80 and over RISK Anticholesteremic Agents PCSK9 Inhibitors Antibodies Monoclonal Middle Aged Hospitalization Clinical trial Treatment Outcome myocardial infarction 1117 Public Health And Health Services Disease Progression Cardiology Female TRIAL Proprotein Convertase 9 INFARCTION Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine Ticagrelor medicine.drug Adult medicine.medical_specialty Serine Proteinase Inhibitors Antibodies Monoclonal Humanized Risk Assessment 1102 Cardiovascular Medicine And Haematology LDL EVENTS 03 medical and health sciences Double-Blind Method Physiology (medical) Internal medicine cholesterol LDL medicine Humans PCSK9 protein TICAGRELOR human LDL-C Aged Science & Technology business.industry cholesterol 1103 Clinical Sciences Proprotein convertase medicine.disease Evolocumab Peripheral Vascular Disease Cardiovascular System & Hematology Cardiovascular System & Cardiology clinical trial [publication type] ATHEROSCLEROTIC CARDIOVASCULAR-DISEASE business Biomarkers |
| Popis: | Background: The FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk) recently showed that the PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor evolocumab significantly reduced major vascular events in patients with stable atherosclerotic cardiovascular disease, including patients with prior myocardial infarction (MI). Within the broad group of patients with prior MI, we hypothesized that readily ascertainable features would identify subsets who derive greater clinical risk reduction with evolocumab. Methods: The 22 351 patients with a prior MI were characterized on the basis of time from most recent MI, number of prior MIs, and presence of residual multivessel coronary artery disease (≥40% stenosis in ≥2 large vessels). The relative and absolute risk reductions in major vascular events, including the primary end point (cardiovascular death, MI, stroke, hospitalization for unstable angina, or coronary revascularization) and the key secondary end point (cardiovascular death, MI, or stroke), with evolocumab in these subgroups were compared. Results: A total of 8402 patients (38%) were within 2 years of their most recent MI; 5285 patients (24%) had ≥2 prior MIs; and 5618 patients (25%) had residual multivessel coronary artery disease. In a multivariable-adjusted model that simultaneously included all 3 high-risk features and other baseline covariates, more recent MI, multiple prior MIs, and residual multivessel coronary disease remained independent predictors of cardiovascular outcomes, with adjusted hazard ratios (HRs) for the primary end point of 1.37 (95% confidence interval [CI],1.22–1.53), 1.78 (95% CI, 1.59–1.99), and 1.39 (95% CI, 1.24–1.56; all P Conclusions: Patients closer to their most recent MI, with multiple prior MIs, or with residual multivessel coronary artery disease are at high risk for major vascular events and experience substantial risk reductions with low-density lipoprotein cholesterol lowering with evolocumab. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01764633. |
| Databáze: | OpenAIRE |
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