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.
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.
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.