Strike early-strike strong lipid-lowering strategy with proprotein convertase subtilisin/kexin type 9 inhibitors in acute coronary syndrome patients: real-world evidence from the AT-TARGET-IT registry.

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European journal of preventive cardiology Pub Date : 2024-11-11 DOI:10.1093/eurjpc/zwae170
Paola Gargiulo, Christian Basile, Gennaro Galasso, Michele Bellino, Debora D'Elia, Giuseppe Patti, Manuel Bosco, Matteo Prinetti, Giuseppe Andò, Francesca Campanella, Giovanni Taverna, Paolo Calabrò, Arturo Cesaro, Fabio Fimiani, Angelo Catalano, Ferdinando Varbella, Antonella Corleto, Francesco Barillà, Saverio Muscoli, Giuseppe Musumeci, Fabrizio Delnevo, Francesco Giallauria, Raffaele Napoli, Italo Porto, Alberto Polimeni, Rossella Quarta, Alessandro Maloberti, Piera Angelica Merlini, Leonardo De Luca, Gavino Casu, Natale Daniele Brunetti, Mario Crisci, Leonardo Paloscia, Claudio Bilato, Ciro Indolfi, Federica Marzano, Sara Fontanarosa, Davide Buonocore, Antonio Luca Maria Parlati, Ermanno Nardi, Maria Prastaro, Andrea Soricelli, Marco Salvatore, Stefania Paolillo, Pasquale Perrone-Filardi, Gianluigi Cuomo, Crescenzo Testa, Gianluca Passaretti, Giuseppe Vallefuoco, Annalisa Romano, Raffaele Dell'Anno, Aurora Merolla, Francesca Paola Iannone
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引用次数: 0

Abstract

Aims: No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in the real world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major cardiovascular (CV) events in the real world.

Methods and results: The lipid control outcome was the percentage of patients reaching the LDL-C target of <55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all-cause death, non-fatal MI, non-fatal stroke, and ischaemia-driven revascularization) during a follow-up in relation to quartiles of LDL-C at first lipid control. We included 771 patients with ACS from the AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischaemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C < 55 mg/dL.

Conclusion: Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early-strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.

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在 ACS 患者中尽早使用 PCSK9i 采取强有力的降脂策略。来自 AT-TARGET-IT 登记的真实世界证据。
目的:目前尚无关于急性冠状动脉综合征(ACS)患者早期开始使用9型丙蛋白转换酶亚基酶/kexin抑制剂(PCSK9i)的数据。本研究调查了在急性冠状动脉综合征住院时开始使用 PCSK9i 对血脂控制和真实世界中主要 CV 事件的影响:血脂控制结果是首次血脂控制时达到 LDL-C < 55 mg/dL 目标值的患者比例。临床结果是随访期间与首次血脂控制时 LDL-C 四分位数相关的复合主要 CV 事件(全因死亡、非致命性心肌梗死、非致命性中风和缺血性血运重建)的发生率:我们纳入了771名AT-TARGET-IT登记处的ACS患者,他们在住院期间或出院时接受了PCSK9i处方治疗。中位 LDL-C 为 137 mg/dL,首次血脂控制时降至 43 mg/dL。527名(68.3%)患者在首次血脂控制时达到了低密度脂蛋白胆固醇目标值,中位时间为住院后37天;其中404名(76.8%)患者出院时接受了他汀类药物加依折麦布的背景治疗。在中位随访11个月期间,不同LDL-C四分位数的事件曲线显示,在首次血脂控制时,LDL-C值较低的四分位数发生4P-MACE、3P-MACE、全因死亡率和缺血性血运重建的风险呈阶梯式下降(结论:在临床实践中,使用 PCSK9i 对 ACS 患者进行早期强化降脂治疗(早出击强策略)是安全有效的,并能降低残余 CV 风险。
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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
期刊最新文献
REDUCE-IT, biomarkers, and confirmation bias: are we missing the forest for the trees? Strike early-strike strong lipid-lowering strategy with proprotein convertase subtilisin/kexin type 9 inhibitors in acute coronary syndrome patients: real-world evidence from the AT-TARGET-IT registry. Eligibility for lipid-lowering therapy when applying systemic coronary risk estimation 2 according to guidelines on apparently healthy middle-aged individuals. Use of combination therapy is associated with improved LDL cholesterol management: 1-year follow-up results from the European observational SANTORINI study. Effects of omega-3 fatty acids on coronary revascularization and cardiovascular events: a meta-analysis.
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