OMega-3 fatty acids in Elderly with Myocardial Infarction - OMEMI
Contribution To Literature:
The OMEMI trial failed to show that PUFA was superior to placebo at preventing adverse cardiovascular outcomes.
The goal of the trial was to evaluate n-3 polyunsaturated fatty acids (PUFAs) compared with placebo among elderly patients with recent myocardial infarction.
Elderly patients with recent myocardial infarction were randomized to 1.8 g n-3 fatty acids (n = 513) versus placebo (n = 514). The study medication contained 930 g of eicosapentaenoic acid (EPA) and 660 g of docosahexaenoic acid (DHA).
- Total number of enrollees: 1,027
- Duration of follow-up: 24 months
- Mean patient age: 74 years
- Percentage female: 29.3%
- Patients 70-82 years of age
- Myocardial infarction 2-8 weeks prior to randomization
- Intolerance to study medication
- Limited life expectancy
Other salient features/characteristics:
- In the PUFA group, serum EPA levels increased 87% and DHA increased 16%.
- In the placebo group, serum EPA levels decreased -13% and DHA decreased -8%.
The primary outcome of all-cause death, nonfatal myocardial infarction, unscheduled revascularization (stent or bypass surgery), stroke, or hospitalization for heart failure at 24 months occurred in 21.0% of the PUFA group compared with 19.8% of the placebo group (p = 0.62). The treatment effect was the same in tested subgroups.
- Atrial fibrillation: 7.2% of the PUFA group compared with 4.0% of the placebo group (p = 0.06)
- Major bleeding: 10.7% of the PUFA group compared with 11.0% of the placebo group (p = 0.87)
Among elderly patients with recent myocardial infarction, PUFA was not beneficial. Major adverse cardiovascular events were similar between treatment groups. There was a numerical increase in atrial fibrillation with PUFA. Major bleeding was similar between the groups.
This study contrasts with the REDUCE-IT trial, which found that icosapent ethyl was associated with a 25% reduction in cardiovascular events. Icosapent ethyl was associated with a 386% increase in serum EPA levels compared with placebo.
Kalstad AA, Myhre PL, Laake K, et al., on behalf of the OMEMI Investigators. Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction: A Randomized Controlled Trial. Circulation 2020;Nov 15:[Epub ahead of print].
Presented by Dr. Are A. Kalstad at the American Heart Association Virtual Scientific Sessions, November 15, 2020.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Lipid Metabolism, Nonstatins, Acute Heart Failure, Interventions and ACS, Stable Ischemic Heart Disease
Keywords: AHA20, AHA Annual Scientific Sessions, Acute Coronary Syndrome, Atrial Fibrillation, Docosahexaenoic Acids, Eicosapentaenoic Acid, Fatty Acids, Omega-3, Fatty Acids, Unsaturated, Geriatrics, Heart Failure, Hemorrhage, Myocardial Infarction, Myocardial Revascularization, Primary Prevention, Stents, Stroke
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