(P168) REDUCTION IN ISCHEMIC EVENTS, INCLUDING CARDIOVASCULAR MORTALITY, WITH ICOSAPENT ETHYL IN PATIENTS WITH PRIOR MYOCARDIAL INFARCTION: REDUCE-IT PRIOR MI

Background: The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) was a multinational, double-blind, randomized trial of 8,179 statin-treated patients with well-controlled low-density lipoprotein cholesterol, elevated triglycerides, and increased cardiovascular risk. In the overall trial, icosapent ethyl significantly reduced important ischemic events, including death from cardiovascular causes. Patients with prior myocardial infarction (MI) are a large, easily identified group known to be at high risk for recurrent ischemic events, including fatal ones.

METHODS AND RESULTS: Prior MI was an allowed inclusion criterion for the established cardiovascular disease cohort in REDUCE-IT; we performed post hoc analyses of these patients with a history of prior MI at baseline. The primary composite endpoint was cardiovascular death, MI, stroke, coronary revascularization, or hospitalization for unstable angina. The key secondary composite endpoint was cardiovascular death, MI, or stroke. Cardiac arrest and sudden cardiac death were tertiary endpoints. All these endpoints were independently and blindly adjudicated. A total of 3693 patients had a history of prior MI. In these patients, the primary endpoint was reduced from 26.1% to 20.2% with icosapent ethyl vs placebo, HR 0.74 (95% CI 0.65, 0.85), P=0.00001. The key secondary endpoint was reduced from 18.0% to 13.3%, HR 0.71 (95% CI 0.61, 0.84), P=0.00006. In addition to significant reductions in time to first events, there were significant reductions in total ischemic events (Figure). There was a 34% relative risk reduction in MI (P=0.00009), a 30% reduction in cardiovascular death (P=0.01), and a 20% lower rate of all-cause mortality (P=0.054). Rates of cardiac arrest (56% relative risk reduction, P=0.02) and sudden cardiac death (40% relative risk reduction, P=0.02) were both significantly reduced.

Conclusion: Patients with a history of prior MI in REDUCE-IT demonstrated large and significant relative and absolute risk reductions in ischemic events with icosapent ethyl versus placebo, including substantially lower rates of MI and cardiovascular death, cardiac arrest, sudden cardiac death, and a trend in all-cause mortality. Such patients should be screened for eligibility for treatment with icosapent ethyl.