Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction: A Serial, Multivessel, Intravascular Ultrasound, Near-Infrared Spectroscopy and Optical Coherence Tomography Imaging Study Rationale and Design of the PACMAN-AMI trial.

Zanchin, Christian; Koskinas, Konstantinos C.; Ueki, Yasushi; Losdat, Sylvain; Häner, Jonas; Bär, Sarah; Otsuka, Tatsuhiko; Inderkum, Andrea; Jensen, Maria Radu Juul; Lonborg, Jacob; Fahrni, Gregor; Ondracek, Anna S; Daemen, Joost; van Geuns, Robert-Jan; Iglesias, Juan; Matter, Christian M; Spirk, David; Juni, Peter; Mach, Francois; Heg, Dik; ... (2021). Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction: A Serial, Multivessel, Intravascular Ultrasound, Near-Infrared Spectroscopy and Optical Coherence Tomography Imaging Study Rationale and Design of the PACMAN-AMI trial. American Heart Journal, 238, pp. 33-44. Elsevier 10.1016/j.ahj.2021.04.006

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BACKGROUND

The risk for cardiovascular adverse events after acute myocardial infarction (AMI) remains high despite potent medical treatment including low-density lipoprotein cholesterol (LDL-C) lowering with statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies substantially reduce LDL-C when added to statin. Alirocumab, a momoclonal antibody to PCSK9, reduces major adverse cardiovascular events after AMI. The effects of alirocumab on coronary atherosclerosis including plaque burden, plaque composition and fibrous cap thickness in patients presenting with AMI remains unknown.

AIMS

To determine the effect of LDL-C lowering with alirocumab on top of high-intensitv statin therapy on intravascular ultrasound (IVUS)-derived percent atheroma volume (PAV), near-infrared spectroscopy (NIRS)-derived maximum lipid core burden index within 4mm (maxLCBI4mm) and optical coherence tomography (OCT)-derived fibrous cap thickness (FCT) in patients with AMI.

METHODS

In this multicenter, double-blind, placebo-controlled trial, 300 patients with AMI (ST-elevation or non-ST-elevation myocardial infarction) were randomly assigned to receive either biweekly subcutaneous alirocumab (150 mg) or placebo beginning <24 hours after the acute event as add-on therapy to rosuvastatin 20 mg. Patients undergo serial IVUS, NIRS and OCT in the two non-infarct related arteries at baseline (at the time of treatment of the culprit lesion) and at 52 weeks. The primary endpoint, change in IVUS-derived PAV, and the powered secondary endpoints, change in NIRS-derived maxLCBI4mm, and OCT-derived minimal FCT, will be assessed 52 weeks post randomization.

SUMMARY

The PACMAN-AMI trial will determine the effect of alirocumab on top of high-intensity statin therapy on high-risk coronary plaque characteristics as assessed by serial, multimodality intracoronary imaging in patients presenting with AMI.

CLINICAL TRIAL REGISTRATION

NCT03067844.

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