Peripheral Artery Disease and Venous Thromboembolic Events After Acute Coronary Syndrome

作者：Gregory G. Schwartz, Philippe Gabríel Steg, Michael J. Szarek, Vera Bittner, Rafael Ugarriza Díaz, Shaun G. Goodman, Yong-Un Kim, J. Wouter Jukema, Robert C. Pordy, Matthew T. Roe, Harvey Douglas White, Deepak L. Bhatt · 发表于：Circulation · 年份：2020 · DOI：10.1161/circulationaha.120.046524 · 被引用次数：193 · 研究领域：Lipoproteins and Cardiovascular Health、Antiplatelet Therapy and Cardiovascular Diseases、Peripheral Artery Disease Management

Background: Patients with acute coronary syndrome are at risk for peripheral artery disease (PAD) events and venous thromboembolism (VTE). PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors reduce lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C) levels. Our objective was to ascertain whether PCSK9 inhibition reduces the risk of PAD events or VTE after acute coronary syndrome, and if such effects are related to levels of lipoprotein(a) or LDL-C. Methods: This was a prespecified analysis of the ODYSSEY OUTCOMES randomized clinical trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome), which was conducted in 18 924 patients with recent acute coronary syndrome on intensive or maximum-tolerated statin treatment who were randomized to the PCSK9 inhibitor alirocumab or placebo. In a prespecified analysis, PAD events (critical limb ischemia, limb revascularization, or amputation for ischemia) and VTE (deep vein thrombosis or pulmonary embolism) were assessed. LDL-C was corrected (LDL-C corrected ) for cholesterol content in lipoprotein(a). Results: At baseline, median lipoprotein(a) and LDL-C corrected were 21 and 75 mg/dL, respectively; with alirocumab, median relative reductions were 23.5% and 70.6%, respectively. PAD events and VTE occurred in 246 and 92 patients, respectively. In the placebo group, risk of PAD events was related to baseline quartile of lipoprotein(a) ( P trend =0.0021), and tended to associate with baseline qua...