Key result
Alirocumab reduces non-ACS chest pain events ~8% vs. placebo after acute coronary syndrome.
Why the study?
Patients with recent ACS commonly experience chest pain affecting quality of life even when not due to recurrent ACS, and the effect of alirocumab on such chest pain was unclear.
Does alirocumab reduce the incidence of chest pain not due to recurrent ACS in patients with recent ACS and elevated atherogenic lipids on optimized statin therapy?
RCT (n=18,894)
Double-blind, placebo-controlled
Randomized
Yes
Does alirocumab reduce the incidence of chest pain not due to recurrent ACS in patients with recent ACS and elevated atherogenic lipids on optimized statin therapy?
In patients with recent ACS, the addition of alirocumab to optimized statin therapy significantly reduced the incidence of non-ischemic chest pain events, potentially improving quality of life.
Answers are grounded in this paper and cite their sources.
May reduce non-ACS chest pain post-ACS; hypothesis-generating and requires prospective confirmation before practice change.
Patients with recent acute coronary syndrome (ACS) commonly experience chest pain, which affects quality of life even when not due to recurrence of ACS. This post hoc analysis of ODYSSEY OUTCOMES assessed the effect of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, on the incidence of chest pain not due to recurrent ACS. Patients with recent ACS ( n = 18,894) and elevated atherogenic lipoprotein levels despite optimized statin therapy were randomized to subcutaneous alirocumab or matching placebo every 2 weeks. Alirocumab dose was adjusted to target low-density lipoprotein cholesterol (LDL-C) 25–50 mg/dL (0.6–1.3 mmol/L) and to avoid consecutive LDL-C <15 mg/dL (0.39 mmol/L). Non-hospitalized chest pain adverse events and chest pain events requiring hospitalization but negatively adjudicated for recurrent ACS were assessed. Chest pain not requiring hospitalization was reported as an adverse event in 1490 patients, including 7.5 % and 8.3 % of alirocumab and placebo groups, respectively. Hospitalization for chest pain negatively adjudicated for recurrent ACS occurred in 952 patients, including 4.8 % and 5.3 % of alirocumab and placebo groups, respectively. Adjusting for baseline covariates, alirocumab use was associated with 8.1 % lower risk of chest pain (either non-hospitalized or hospitalized events) versus placebo (HR: 0.919; 95 % CI: 0.845–0.998; P = 0.046); a landmark analysis at 7 months showed a larger, 11.7 % risk reduction (HR: 0.883; 95 % CI: 0.793–0.984; P = 0.024). Alirocumab use is associated with reduced incidence of chest pain events after ACS, including those not requiring hospitalization and those requiring hospitalization but not adjudicated as recurrent ACS. NCT01663402
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Geba et al. (2024) conducted an RCT in Recent acute coronary syndrome (ACS) with elevated atherogenic lipoproteins (n=18,894). Alirocumab vs. Matching placebo was evaluated on Combined incidence of chest pain (non-hospitalized adverse events and hospitalized chest pain negatively adjudicated for recurrent ACS) (HR 0.919, 95% CI 0.845-0.998, p=0.046). Alirocumab reduced the risk of non-hospitalized and negatively adjudicated hospitalized chest pain events by 8.1% compared to placebo in patients with recent acute coronary syndrome (HR 0.919, 95% CI 0.845-0.998, P=0.046).
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