The New England Journal of MedicineApolipoprotein A1 Infusions and Cardiovascular Outcomes after Acute Myocardial Infarction

Investigating Apolipoprotein A1: Lack of Impact on Cardiovascular Risk Post-Myocardial Infarction

In a substantial international trial, researchers explored the efficacy of CSL112, a human apolipoprotein A1 derivative, in reducing recurrent cardiovascular events following acute myocardial infarction among patients with multivessel coronary artery disease. Despite hopes that enhancing cholesterol efflux capacity could benefit these high-risk patients, the study provides crucial insights into the intervention’s impact over several follow-up periods.

Study Design:

• Study Type: International, double-blind, placebo-controlled trial.
• Participants: 18,219 patients with acute myocardial infarction and multivessel coronary artery disease, plus additional cardiovascular risk factors.
• Intervention: Four weekly infusions of 6 g of CSL112 or a matching placebo, administered within five days of medical contact for myocardial infarction.
• Follow-Up Periods: Primary endpoint assessment at 90 days, with additional follow-ups at 180 and 365 days.

Key Findings:

• 90-Day Outcome: No significant difference in the risk of myocardial infarction, stroke, or death from cardiovascular causes between CSL112 and placebo groups (4.8% vs. 5.2%; hazard ratio, 0.93).
• Extended Outcomes: Similar results at 180 days (6.9% vs. 7.6%; hazard ratio, 0.91) and 365 days (9.8% vs. 10.5%; hazard ratio, 0.93).
• Safety Profile: Comparable rates of adverse events in both groups, though hypersensitivity events were more common in the CSL112 group.

HCN Medical Memo
Despite CSL112’s promising mechanism, its real-world applicability in preventing further cardiovascular incidents remains limited, suggesting that current treatment strategies should continue to be evaluated alongside emerging therapies.

More on Heart Attack/Myocardial Infarction