In-hospital initiation of PCSK9 inhibitor and short-term lipid control in patients with acute myocardial infarction

Abstract

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes when added to conventional statin therapy. This study aims to investigate the efficacy and safety of in-hospital initiation of PCSK9 inhibitors among patients with acute myocardial infarction (AMI) based on real-world experience.

Methods and results: Data were collected from the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University between January 2016 and December 2020. A total of 7556 AMI patients were screened for eligibility. Propensity Score Match (PSM) was employed, and covariates were age, sex, admission blood pressure and lipid profiles. Eligible participants were (1) propensity-matched 1:2:2 of statin plus evolocumab (dual therapy) vs. statin vs. statin plus ezetimibe. Ninety-five statin plus evolocumab users achieved significantly decreased low density lipoprotein (LDL) levels (0.92 ± 0.62 mmol/L in the 1st month and 1.17 ± 0.73 in the 3rd month) and a promising attainment rate of LDL (79.5% in the 1st month and 80.0% in the 3rd month) compared to the other two groups. (2) Propensity-matched 1:2:2 of statin plus ezetimibe evolocumab (triple therapy) vs. statin vs. statin plus ezetimibe. Similarly, 75 triple medication users achieved significantly decreased LDL levels and a promising attainment rate of LDL compared to the other two groups. In-hospital mortality and readmission rates within 3 months were then analyzed, and a decreased readmission rate was observed with PCSK9i therapy.

Conclusions: Based on the present single-center real-world PSM-adjusted study, PCSK9i has been effective in short-term lipid control among AMI patients. The long-term effectiveness for reducing major cardiovascular events among AMI patients based on real-world experience remains to be explored.

Trial registration: The study was registered at ClinicalTrials.gov, ClinicalTrials.gov ID: NCT05184530.

Keywords: Acute myocardial infarction; Low density lipoprotein; Proprotein convertase Subtilisin/kexin type 9 (PCSK9) inhibitors; Statin.

Conflict of interest statement

Not applicable.

© 2022. The Author(s).

Figures

Fig. 1

Patient selection, propensity score matching and follow-up

Fig. 2

LDL level and compliance rate on admission and short-term follow-up among different lipid-lowering strategies in AMI patients. A. LDL level and compliance rate among different lipid-lowering strategies on admission and at the 1- and 3-month follow-ups. Each point represents one AMI patient’s lipid data. B LDL alterations among different lipid-lowering strategies on admission and at the 1st and 3rd month follow-ups. Data are shown as the mean ± SEM LDL Target Level = 1.4 mmol/L

Fig. 3

Lipid profile alterations and short-term follow-up among statin plus evolocumab/statin/statin plus ezetimibe lipid-lowering strategies in AMI patients after PSM adjustment. A LDL level and compliance rate among different lipid-lowering strategies on admission and at the 1- and 3-month follow-ups. Each point represents one AMI patient’s lipid data after PSM adjustment. LDL (B) and ApoB (C) alterations among different lipid-lowering strategies on admission and at the 1- and 3-month follow-ups. Data are shown as the mean ± SEM. D Readmission rate among each group. Ninety-five statin plus evolocumab users, 190 statin plus ezetimibe users and 190 statin users were chosen after 1:2:2 propensity score matching. For statistical analysis, one-way ANOVA followed by Sidak’s multiple comparison test was applied, * P < 0.05, ***P < 0.001

Fig. 4

Lipid profile alterations and short-term follow-up among statin plus ezetimibe plus evolocumab/statin/statin plus ezetimibe lipid-lowering strategies in AMI patients after PSM adjustment. A LDL level and compliance rate among different lipid-lowering strategies on admission and at the 1- and 3-month follow-ups. Each point represents one AMI patient’s lipid data after PSM adjustment. LDL (B) and ApoB (C) alterations among different lipid-lowering strategies on admission and at the 1- and 3-month follow-ups. Data are shown as the mean ± SEM. D Readmission rate among each group. Seventy-five statin plus ezetimibe plus evolocumab users, 150 statin plus ezetimibe users and 150 statin users were chosen after 1:2:2 propensity score matching. For statistical analysis, one-way ANOVA followed by Sidak’s multiple comparison test was applied, * P < 0.05, ** P < 0.01, *** P < 0.001