Treatment With Icosapent Ethyl to Reduce Ischemic Events in Patients With Prior Percutaneous Coronary Intervention: Insights From REDUCE-IT PCI

• Main Authors: Ballantyne, C.M (Author), Bhatt, D.L (Author), Brinton, E.A (Author), Budoff, M.J (Author), Doyle, R.T., Jr (Author), Gibson, C.M (Author), Giugliano, R.P (Author), Granowitz, C. (Author), Jacobson, T.A (Author), Jiao, L. (Author), Juliano, R.A (Author), Ketchum, S.B (Author), Miller, M. (Author), Peterson, B.E (Author), Pinto, D. (Author), Steg, P.G (Author), Tardif, J.-C (Author), Verma, S. (Author)
• Format: Article
• Language: English
• Published: American Heart Association Inc. 2022
• Subjects: eicosapentaenoic acid; icosapent ethyl; prevention; revascularization
• Online Access: View Fulltext in Publisher

 BACKGROUND: Patients who undergo percutaneous coronary intervention (PCI) are at increased risk for recurrent cardiovascular events despite aggressive medical therapy. METHODS AND RESULTS: This post hoc analysis focused on the subset of patients with prior PCI enrolled in REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, randomized, double-blind, placebo-controlled trial of icosapent ethyl versus placebo. Icosapent ethyl was added to statins in patients with low-density lipoprotein cholesterol <100 mg/dL and fasting triglycerides 135–499 mg/dL. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization. There were 8179 patients randomized in REDUCE-IT followed for a median of 4.9 years, and 3408 (41.7%) of them had a prior PCI with a median follow-up of 4.8 years. These patients were randomized a median of 2.9 years (11 days to 30.7 years) after PCI. Among patients treated with icosapent ethyl versus placebo, there was a 34% reduction in the primary composite end point (hazard ratio [HR], 0.66; 95% CI, 0.58–0.76; P<0.001; number needed to treat4.8 years=12) and a 34% reduction in the key secondary composite end point of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (HR, 0.66; 95% CI, 0.56–0.79; P<0.001; NNT4.8 years=19) versus placebo. Similarly, large reductions occurred in total coronary revascularizations and revascularization subtypes. There was also a 39% reduction in total events (rate ratio, 0.61; 95% CI, 0.52–0.72; P<0.001). CONCLUSIONS: Among patients treated with statins with elevated triglycerides and a history of prior PCI, icosapent ethyl substantially reduced the risk of recurrent events during an average of ~5 years of follow-up with a number needed to treat of only 12. REGISTRATION: URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT01492361. © 2022 The Authors.