Abstract:
BACKGROUND:Cholesterol reduction with proprotein convertase subtilisin-kexin type 9 inhibitors reduces ischemic events; however, the cost-effectiveness in statin-treated patients with recent acute coronary syndrome remains uncertain. OBJECTIVES:This study sought to determine whether further cholesterol reduction with alirocumab would be cost-effective in patients with a recent acute coronary syndrome on optimal statin therapy. METHODS:A cost-effectiveness model leveraging patient-level data from ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was developed to estimate costs and outcomes over a lifetime horizon. Patients (n = 18,924) had a recent acute coronary syndrome and were on high-intensity or maximum-tolerated statin therapy, with a baseline low-density lipoprotein cholesterol (LDL-C) level ≥70 mg/dl, non-high-density lipoprotein cholesterol ≥100 mg/dl, or apolipoprotein B ≥80 mg/l. Alirocumab 75 mg or placebo was administered subcutaneously every 2 weeks. Alirocumab was blindly titrated to 150 mg if LDL-C remained ≥50 mg/dl or switched to placebo if 2 consecutive LDL-C levels were <15 mg/dl. Incremental cost per quality-adjusted life-year (QALY) was determined with the addition of alirocumab versus placebo and, based on clinical efficacy findings from the trial, was stratified by baseline LDL-C levels ≥100 mg/dl and <100 mg/dl. RESULTS:Across the overall population recruited to the ODYSSEY OUTCOMES trial, using an annual treatment cost of US$5,850, the mean overall incremental cost-effectiveness ratio was US$92,200 per QALY (base case). The cost was US$41,800 per QALY in patients with baseline LDL-C ≥100 mg/dl, whereas in those with LDL-C <100 mg/dl the cost per QALY was US$299,400. Among patients with LDL-C ≥100 mg/dl, incremental cost-effectiveness ratios remained below US$100,000 per QALY across a wide variety of sensitivity analyses. CONCLUSIONS:In patients with a recent acute coronary syndrome on optimal statin therapy, alirocumab improves cardiovascular outcomes at costs considered intermediate value, with good value in patients with baseline LDL-C ≥100 mg/dl but less economic value with LDL-C <100 mg/dl. (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab [ODYSSEY OUTCOMES]; NCT01663402).
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Bhatt DL,Briggs AH,Reed SD,Annemans L,Szarek M,Bittner VA,Diaz R,Goodman SG,Harrington RA,Higuchi K,Joulain F,Jukema JW,Li QH,Mahaffey KW,Sanchez RJ,Roe MT,Lopes RD,White HD,Zeiher AM,Schwartz GG,Gabriel Steg P,doi
10.1016/j.jacc.2020.03.029subject
Has Abstractpub_date
2020-05-12 00:00:00pages
2297-2308issue
18eissn
0735-1097issn
1558-3597pii
S0735-1097(20)34635-0journal_volume
75pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVES:We developed an automatic quantitative algorithm for the measurement of regional myocardial wall motion and wall thickening from three-dimensional gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomographic images. BACKGROUND:The algorithm measures the motion of the three...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00276-3
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVES:This study sought to investigate the prevalence and mechanisms underlying right ventricular (RV) dyssynchrony in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using tissue Doppler echocardiography (TDE). BACKGROUND:An ARVD/C is characterized by fibrofatty replacement of RV myocardium an...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2009.04.038
更新日期:2009-07-28 00:00:00
abstract:OBJECTIVES:The objective of this study was to identify predictors of defibrillation threshold in patients undergoing epicardial defibrillator implantation. BACKGROUND:Factors that predict epicardial defibrillation efficacy are poorly defined. METHODS:The data from 375 consecutive adult patients were reviewed. After e...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/0735-1097(93)90379-f
更新日期:1993-06-01 00:00:00
abstract::Kawasaki disease (KD) is an acute, self-limited vasculitis that typically occurs in young children and was first described by Japanese pediatrician Tomisaku Kawasaki in 1967. Although originally thought to be a rare condition, KD has become the most common cause of acquired heart disease in the pediatric age group in ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2009.04.102
更新日期:2009-11-17 00:00:00
abstract::The safety and efficacy of a new clinical synchronized diastolic retroperfusion mechanical pump and autoinflatable balloon catheter was studied in 10 dogs during and after 6 hours of left anterior descending coronary artery occlusion. Eight other dogs served as the untreated control group. Infarct size measured by tri...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80168-6
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVES:This study sought to characterize left atrial (LA) sinus rhythm electrogram (EGM) patterns and their relationship to parasympathetic responses during atrial fibrillation (AF) ablation. BACKGROUND:The mechanistic basis of fractionated LA EGMs in patients with paroxysmal AF is not well understood. METHODS:We...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2007.03.069
更新日期:2007-10-02 00:00:00
abstract:OBJECTIVES:Our purpose was to quantitate and confirm specific echogenic immunoliposome (ELIP) atheroma component enhancement in vivo. BACKGROUND:Targeted ELIPs for ultrasonic detection and staging of active molecular components of endothelium and atheroma have been developed. METHODS:In Yucatan miniswine, the endothe...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.07.048
更新日期:2004-02-04 00:00:00
abstract:OBJECTIVES:We evaluated C-reactive protein (CRP) alone and in conjunction with a rapid qualitative assay for cardiac-specific troponin T (cTnT) for predicting 14-day mortality in patients with unstable angina or non-Q wave myocardial infarction (NQMI). BACKGROUND:Elevated CRP has been found to correlate with higher ri...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/s0735-1097(98)00136-3
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine the effects of glycoprotein (GP) IIb/IIIa antagonists (abciximab, eptifibatide, and tirofiban) and other inhibitors on translocation of CD40L from intraplatelet stores to the platelet surface and on the release of soluble CD40L (sCD40L) from platelets. BACKGROUND:CD4...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.12.055
更新日期:2004-06-16 00:00:00
abstract::Previous studies have suggested that there exists a functional border zone in myocardium at the lateral margins of an ischemic area. The functional border zone is normally perfused but is characterized by abnormal contractile function. To define the spatial characteristics of this border zone, circumferential maps of ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(86)80106-1
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVES:To evaluate whether use of beta-adrenergic blocking agents, alone or in combination with specific antiarrhythmic therapy, is associated with improved survival in persons with ventricular fibrillation (VF) or symptomatic ventricular tachycardia (VT). BACKGROUND:The ability of beta-blockers to alter the morta...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(99)00234-x
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVES:This study investigated the effects of androgens on gene expression in male- and female-donor macrophages. BACKGROUND:Men have more severe coronary disease than women. Androgen exposure increases foam cell formation in male but not female macrophages, and male macrophages express >4-fold more androgen recep...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.07.002
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVES:The goal of this study was to determine the predictive value of pregnancy-associated plasma protein-A (PAPP-A) in patients with acute coronary syndromes (ACS). BACKGROUND:Pregnancy-associated plasma protein-A is a zinc-binding matrix metalloproteinase abundantly expressed in eroded and ruptured plaques and ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2004.09.060
更新日期:2005-01-18 00:00:00
abstract:OBJECTIVES:Because the renin-angiotensin-aldosterone system (RAS) modifies cardiovascular autonomic regulation, we studied the possible associations between baroreflex sensitivity (BRS) and polymorphism in the RAS genes. BACKGROUND:Wide intersubject variability in BRS is not well explained by cardiovascular risk facto...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00506-9
更新日期:2000-01-01 00:00:00
abstract::The relation among right ventricular preload, afterload and ejection fraction in patients with mitral valve disease has not been well elucidated. In this study, measurements were made of intracardiac pressures and forward cardiac output during cardiac catheterization (n = 43), the ejection fraction by radionuclide ang...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(84)80278-8
更新日期:1984-06-01 00:00:00
abstract:OBJECTIVES:We sought to determine the predictors of heart failure (HF) development in long-term survivors of myocardial infarction (MI). BACKGROUND:Modern strategies of acute MI care have resulted in an increasing proportion of survivors at heightened risk of future non-fatal events, including HF. METHODS:We assessed...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(03)01057-x
更新日期:2003-10-15 00:00:00
abstract:OBJECTIVES:This was a prospective, randomized, controlled study designed to determine the effect of resistance exercise training on bone metabolism in heart transplant recipients. BACKGROUND:Osteoporosis frequently complicates heart transplantation. No preventative strategy is generally accepted for glucocorticoid-ind...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(96)00347-6
更新日期:1996-11-15 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine the relation of the mitral flow velocity curves to left ventricular filling pressures in patients with two different types of myocardial problems: hypertrophic cardiomyopathy and severe left ventricular systolic dysfunction. BACKGROUND:Previous studies have suggested...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/S0735-1097(96)00315-4
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVES:We sought to compare anterograde and retrograde balloon dilation of severe aortic valve stenosis in neonates. BACKGROUND:There is a high incidence of iliofemoral artery complications after retrograde balloon dilation of the aortic valve in the neonate. Therefore, a nonarterial technique of catheter access t...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00266-0
更新日期:1997-10-01 00:00:00
abstract::Percutaneous transluminal coronary angioplasty was performed as primary therapy in 215 consecutive patients (aged 56 +/- 11 years, 75% male) with acute myocardial infarction and single vessel coronary artery disease. Wide patency of the infarct-related artery was restored in 212 patients (99%). Complications consisted...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(90)90621-u
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the prognostic value of community-based myocardial perfusion imaging (MPI) and to assess the incremental value of individual components of (99m)Tc-sestamibi single photon emission computed tomography (SPECT). BACKGROUND:Although the most rapid growth of MPI has been...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.07.041
更新日期:2004-01-21 00:00:00
abstract::Because the use of herbal therapies in the U.S. is escalating, it is essential to be aware of clinical and adverse effects, doses and potential drug-herb interactions. A consumer poll in 1998 indicated that one-third of respondents use botanical remedies, and nearly one in five taking prescription medications also use...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/s0735-1097(02)01749-7
更新日期:2002-04-03 00:00:00
abstract:OBJECTIVES:We sought to decipher metabolic processes servicing the increased energy demand during persistent atrial fibrillation (AF) and to ascertain whether metabolic derangements might instigate this arrhythmia. BACKGROUND:Whereas electrical, structural, and contractile remodeling processes are well-recognized cont...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2007.09.055
更新日期:2008-02-05 00:00:00
abstract:OBJECTIVES:The purpose of this study is to investigate the role of endogenous endothelin-1 (ET-1) in myocardial growth in Bio 14.6 Syrian cardiomyopathic hamsters (Bio). BACKGROUND:While ET-1, as a growth-promoting peptide, has been implicated in the development of secondary cardiac hypertrophy, the role of endogenous...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00564-6
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVES:The present study was aimed to evaluate the efficacy of a specific algorithm with continuous atrial dynamic overdrive pacing to prevent atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. BACKGROUND:Atrial fibrillation occurs in 30% to 40% of patients after cardiac surgery with a pea...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(00)00608-2
更新日期:2000-05-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine quality of life (QOL) and exercise performance (EP) in patients with persistent atrial fibrillation (AF) converted to sinus rhythm (SR) compared with those remaining in or reverting to AF. BACKGROUND:Restoration of SR in patients with AF improving QOL and EP remain...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2006.03.051
更新日期:2006-08-15 00:00:00
abstract:OBJECTIVES:The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term. BACKGROUND:Although a substantial body of data exists in...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2011.08.050
更新日期:2011-11-08 00:00:00
abstract:OBJECTIVES:This study used a meta-analysis to examine HLA-DR frequencies in rheumatic heart disease and prospectively examined other class II allelic disease associations. BACKGROUND:Studies of rheumatic heart disease have reported HLA class II allelic associations, but these are inconsistent. METHODS:A meta-analysis...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,meta分析
doi:10.1016/0735-1097(95)80022-9
更新日期:1995-08-01 00:00:00
abstract::In vivo plaque recognition may be important for safe and precise intra-arterial atheroma ablation during laser coronary angioplasty. This study examined the feasibility and sensitivity of utilizing quantitative fluorescence spectroscopy and video-enhanced fluorescence imaging for plaque identification in atherosclerot...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90361-0
更新日期:1988-07-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to answer the question of whether stimulation after administration of catecholamines is mandatory for identifying unsuccessful ablations of atrioventricular node re-entrant tachycardia (AVNRT). BACKGROUND:The success of radiofrequency (RF) catheter ablation in AVNRT is confirme...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01798-3
更新日期:2002-02-20 00:00:00