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Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction: The PACMAN-AMI Randomized Clinical Trial

Räber, Lorenz, Ueki, Yasushi, Otsuka, Tatsuhiko, Losdat, Sylvain, Häner, Jonas D., Lonborg, Jacob, Fahrni, Gregor, Iglesias, Juan F., van Geuns, Robert-Jan, Ondracek, Anna S., Radu Juul Jensen, Maria D., Zanchin, Christian, Stortecky, Stefan, Spirk, David, Siontis, George C. M., Saleh, Lanja, Matter, Christian M., Daemen, Joost, Mach, François, Heg, Dik, Windecker, Stephan, Engstrøm, Thomas, Lang, Irene M., Koskinas, Konstantinos C., PACMAN-AMI collaborators, Ambühl, Maria, Bär, Sarah, Frenk, André, Morf, Laura U., Inderkum, Andrea, Leuthard, Stefanie, Kavaliauskaite, Raminta, Rexhaj, Emrush, Shibutani, Hiroki, Mitter, Vera R., Kaiser, Christoph, Mayr, Manuel, Eberli, Franz R., O'Sullivan, Crochan J., Templin, Christian, von Eckardstein, Arnold, Ghandilyan, Art, Pawar, Ravindra, Jonker, Hans, Hofbauer, Thomas, Goliasch, Georg, Bang, Lia, Sørensen, Rikke, Tovar Forero, Maria N., Degrauwe, Sophie, Ten Cate, Tim·2022·JAMA
DOI 10.1001/jama.2022.5218
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Abstract

Importance Coronary plaques that are prone to rupture and cause adverse cardiac events are characterized by large plaque burden, large lipid content, and thin fibrous caps. Statins can halt the progression of coronary atherosclerosis; however, the effect of the proprotein convertase subtilisin kexin type 9 inhibitor alirocumab added to statin therapy on plaque burden and composition remains largely unknown. Objective To determine the effects of alirocumab on coronary atherosclerosis using serial multimodality intracoronary imaging in patients with acute myocardial infarction. Design, setting, and participants The PACMAN-AMI double-blind, placebo-controlled, randomized clinical trial (enrollment: May 9, 2017, through October 7, 2020; final follow-up: October 13, 2021) enrolled 300 patients undergoing percutaneous coronary intervention for acute myocardial infarction at 9 academic European hospitals. Interventions Patients were randomized to receive biweekly subcutaneous alirocumab (150 mg; n = 148) or placebo (n = 152), initiated less than 24 hours after urgent percutaneous coronary intervention of the culprit lesion, for 52 weeks in addition to high-intensity statin therapy (rosuvastatin, 20 mg). Main outcomes and measures Intravascular ultrasonography (IVUS), near-infrared spectroscopy, and optical coherence tomography were serially performed in the 2 non-infarct-related coronary arteries at baseline and after 52 weeks. The primary efficacy end point was the change in IVUS-d…

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Research works printed but not linked: 28

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Metadata

Authors
Räber, L., Ueki, Y., Otsuka, T., Losdat, S., Häner, J. D., Lonborg, J., Fahrni, G., Iglesias, J. F., van Geuns, R.-J., Ondracek, A. S., Radu Juul Jensen, M. D., Zanchin, C., Stortecky, S., Spirk, D., Siontis, G. C. M., Saleh, L., Matter, C. M., Daemen, J., Mach, F., Heg, D., Windecker, S., Engstrøm, T., Lang, I. M., Koskinas, K. C., collaborators, P.-A., Ambühl, M., Bär, S., Frenk, A., Morf, L. U., Inderkum, A., Leuthard, S., Kavaliauskaite, R., Rexhaj, E., Shibutani, H., Mitter, V. R., Kaiser, C., Mayr, M., Eberli, F. R., O'Sullivan, C. J., Templin, C., von Eckardstein, A., Ghandilyan, A., Pawar, R., Jonker, H., Hofbauer, T., Goliasch, G., Bang, L., Sørensen, R., Tovar Forero, M. N., Degrauwe, S., & Ten Cate, T.
Affiliations
  • Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
  • CTU Bern, University of Bern, Bern, Switzerland
  • Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  • Department of Cardiology, University Hospital Basel, Basel, Switzerland
  • Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
  • Department of Cardiology, Radboud UMC, Nijmegen, the Netherlands
  • Department of Cardiology, Medical University of Vienna, Vienna, Austria
  • Department of Pharmacology, Bern University Hospital, Bern, Switzerland, and Sanofi, Switzerland
  • Institute of Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
  • Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
  • Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
  • for the PACMAN-AMI collaborators
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2022-05-10
Volume
327
Issue
18
Pages
1771
ISSN
0098-7484
DOI
10.1001/jama.2022.5218
Cited by
591
References
4
Language
en

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