The following is a summary of “Effect of Reconstituted Human Apolipoprotein A-I on Recurrent Ischemic Events in Survivors of Acute MI,” published in the June 2024 issue of Cardiology by Povsic et al.

The AEGIS-II trial studied the efficacy of CSL112, an intravenous form of human plasma-derived apolipoprotein A-I (apoA-I), in reducing plaque disruption risk and risk of myocardial infarction (MI) with high risk.

Researchers conducted a prospective study examining how the CSL112 therapy affects the rates of cardiovascular (CV) death and recurrence in patients with MI. 

They conducted the AEGIS-II trial, involving 18,219 patients with high-risk acute MI. Adults aged ≥18 years with type 1 MI and multivessel coronary artery disease with risk factors were eligible. Patients received 4 weekly infusions of CSL112 (6g) or placebo intravenously for 30 days. Follow-up was conducted on days 29, 60, and 90 and subsequently every 90 days until the final visit on day 365.

The results showed that CSL112 group had 11% to 16% lower incidence of death in CV and type 1 MI (HR:0.84, 95% CI: 0.7-1.0; P=0.056 at day 90 and HR:0.86, 95% CI: 0.74-0.99; P=0.048 at day 180, and HR:0.89; 95% CI: 0.79-1.01; P=0.07 at day 365). Incidence of death in CV or any MI was also lower (HR:0.92, 95% CI: 0.80-1.05 at day 90, HR:0.89, 95% CI: 0.79-0.996 at day 180, HR:0.91, 95% CI: 0.83-1.01 at day 365). The effects of CSL112 treatment on MI were predominantly observed for type 1 MI and type 4b (MI due to stent thrombosis). 

Investigators concluded that CSL112 did not significantly reduce primary study endpoints. However, patients receiving CSL112 had fewer deaths in CV and MIs, including type-1 and stent thrombosis-related MIs. 

Source: jacc.org/doi/10.1016/j.jacc.2024.03.396