Results:

Of the 18,924 patients, mean age was about 60 years and higher in those with prior CABG, 22% were female; 83% had a recent MI, 17% had high-risk unstable angina, and randomized at a median 2.6 months from qualifying ACS. Those with prior CABG were older, less often female, had greater atherosclerotic cardiovascular disease (ASCVD) and risk factors including hypertension, diabetes, less beta-blocker treatment, less likely on high-intensity statins, and more likely on ezetimibe, with higher baseline high-density lipoprotein cholesterol, non–high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein (a). The rate of MACE was higher (27.7%) in those with prior CABG than those with CABG at time of index ACS (7.1%) and those without CABG (9.5%). Patients with prior CABG had higher rates of individual primary and secondary events, which persisted after adjustment for baseline data. Alirocumab reduced MACE in the overall study (hazard ratio, 0.85; 95% confidence interval, 0.78-0.93) with a consistent relative risk reduction in each CABG group. Absolute risk reduction was greatest in those with prior CABG (6.4; number needed to treat [NNT], 2.8 years = 16) compared to index CABG (0.9%; NNT, 2.8 years = 111), and no CABG (1.3%; NNT, 2.8 years = 77). Absolute reductions in the risk of specific endpoints were greater in the prior CABG group compared to index and no CABG including CHD death (3.0% vs. ≤0.5%), nonfatal MI, coronary revascularization, and CV and all-cause death.