REDUCE-IT REVASC Suggests Icosapent Ethyl Cuts Rate of Revascularizations

Results of the REDUCE-IT REVASC study are shedding additional light on the cardiovascular benefits of icosapent ethyl (Vascepa).

Presented at the Society of Cardiovascular Angiography and Interventions (SCAI) 2020 Scientific Sessions, the latest prespecified analysis of the landmark REDUCE-IT trial outline the impact of icosapent ethyl on first revascularizations and a slew of revascularization subtypes.

"Overall, there was a 34% reduction in first revascularization events, and even higher reductions in subsequent revascularization events among statin-stabilized patients treated with icosapent ethyl versus placebo,” said lead investigator Benjamin Peterson, MD, interventional cardiology fellow at Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, in a statement. “There was also a significant 32% reduction in stenting and a 39% reduction in the need for coronary artery bypass grafting (CABG) in this double-blind, placebo-controlled trial with independent adjudication of events.”

As part of the REDUCE-IT trial, investigators designed multiple prespecified sub-analyses examining icosapent ethyl’s impact on multiple endpoints across various patient subgroups. Using data from the 8179-patient multicenter, double-blind, placebo-controlled trial, REDUCE-IT REVASC was designed to evaluate the agent’s benefit in regard to multiple forms of revascularization.

Briefly, results of REDUCE-IT indicated icosapent ethyl use was associated with a 25% reduction in relative risk of major adverse cardiovascular events including cardiovascular death, stroke, myocardial infarctions, hospitalization for unstable angina, or revascularization.

The specific revascularization endpoints included in REDUCE-IT REVASC were first emergent or urgent revascularization, emergent revascularization, urgent revascularization, elective revascularization, and salvage revascularization.

Over a median of 4.9 years of follow-up, rates of first coronary revascularization per 1000 patient-years were 22.5 in the icosapent ethyl group and 33.7 in the placebo group—representing a 34% reduction in risk of first coronary revascularization event (HR, 0.66; 95% CI, 0.58-0.76; P <.0001; NNT=25).

Patients receiving icosapent ethyl also noted reductions in emergent or urgent revascularization (HR, 0.65; 95% CI, 0.55-0.78; P <.0001), emergent revascularization (HR, 0.62; 95% CI, 0.42-0.92; P=.016), urgent revascularization (HR, 0.66; 95% CI, 0.54-0.79; P <.0001), and elective revascularization (HR, 0.68; 95% CI, 0.57-0.82; P <.0001).

Investigators noted rates per 1000 patient-years for emergent revascularization were 2.3 and 3.8 in the icosapent ethyl and placebo groups, respectively. Additionally, results indicated only 2 instances of salvage revascularization occurred during REDUCE-IT and both were among the placebo group—yielding rates of 0.0 per 1000 patient-years for icosapent ethyl and 0.1 per 1000 patient-years for placebo.

Investigators also highlighted reductions of 32% (HR, 0.68; 95% CI, 0.59-0.79; P <.0001) in percutaneous coronary intervention and 39% (HR, 0.61; 95% CI, 0.45&#8208;0.81; P=.0005) in CABG with use of icosapent ethyl compared to placebo.

"We were able to show that treating patients with icosapent ethyl who have elevated triglycerides on statin therapy, and who also have either cardiovascular disease or diabetes plus cardiovascular risk factors, resulted in a significant reduction in revascularization, including coronary stenting and cardiac bypass surgery," added Benjamin, in the aforementioned statement.

This study, “Reduction of Revascularizations in Patients with Hypertriglyceridemia with Icosapent Ethyl: Insights from REDUCE&#8208;IT REVASC,” was presented at SCAI 2020.