Alirocumab does not impact AF risk after ACS
In patients with ACS, the PCSK9 inhibitor alirocumab did not impact the development of atrial fibrillation compared with placebo, according to new data from the ODYSSEY Outcomes trial.
While history of AF conferred greater risk for major adverse CV events during follow-up, the risk did not vary by assignment to alirocumab (Praluent, Sanofi/Regeneron) or placebo, according to the researchers.
As Healio previously reported, in the main results of ODYSSEY Outcomes, alirocumab was associated with reduced risk for major adverse CV events, defined as CHD death, nonfatal MI, ischemic stroke and unstable angina requiring hospitalization, and all-cause mortality in patients with ACS already being treated with statin therapy.
For the present analysis, Renato D. Lopes, MD, MHS, PhD, professor of medicine at Duke University School of Medicine and member of the Duke Clinical Research Institute, and colleagues determined factors associated with development of AF in the trial population of 18,924 patients who had recent ACS at baseline and elevated lipid levels despite statin therapy. Median follow-up was 2.8 years.
Among the cohort, 96.5% had no history of AF at baseline. Among that population, 2.7% had incident AF during follow-up, Lopes and colleagues wrote in The American Journal of Medicine.
Predictors of AF development were older age, history of HF, history of MI and higher BMI, but assignment to alirocumab or placebo were not predictors (HR = 0.91; 95% CI, 0.77-1.09), the researchers wrote.
Patients with a history of AF at baseline were more likely to have a major adverse CV event at follow-up than those without a history of AF (8.8 events per 100 patient-years vs. 3.7 events per 100 patient-years), but there was no interaction between AF history and assignment to alirocumab or placebo on risk for major adverse CV events (P for interaction = .78), according to the researchers.
“History of atrial fibrillation is an independent predictor of recurrent cardiovascular events after acute coronary syndrome. While alirocumab did not modify the risk of incident atrial fibrillation after acute coronary syndrome, it did reduce the risk of major adverse CV events, regardless of prior atrial fibrillation history,” Lopes and colleagues wrote. “As this was a post hoc analysis, our results should be taken to be exploratory.”