Possibilities of proprotein convertase subtilisin / kexin type 9 inhibition after acute coronary syndrome

Introduction. Uncorrected dyslipidemia worsens the prognosis after acute coronary syndrome (ACS). The effective lipid-lowering therapy (LLT) may be important including proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9). There is not enough data about the effect of iPCSK9 initiation time on ACS outcomes.
Aim. To evaluate the effect of iPCSK9 initiation time on ACS outcomes during 18 months of follow-up.
Materials and methods. We observed 33 consecutive patients discharged from the hospital who met the following criteria: 1) hospitalization with ACS, 2) low-density lipoprotein cholesterol (LDL-C) > 3.9 mmol/l, 3) consent to visits at 3, 6, 12 and 18 months after ACS, 4) initiation of iPCSK9 therapy within a year after discharge. In 17 patients iPCSK9 therapy was initiated ≥3 months (group 1), and in 16 patients – <3 months after ACS (group 2). LLT was performed in outpatient clinics or regional lipid center. Adverse outcomes were monitored for 18 months.
Results. 6 and 12 months after ACS the proportions of individuals with target LDL-C values in group 2 were 2.3 (p = 0.009) and 1.6 (p = 0.024) times higher than in group 1. In groups 1 and 2, the proportions of individuals requiring cardiovascular rehospitalizations were 9 (52.9%) and 2 (12.5%), respectively, p = 0.017. There were no fatal outcomes. The need for rehospitalizations was inversely correlated with the early start of PCSK9-targeted therapy (R = -0.47; p = 0.0001) as well as with the treatment at the lipid center (R = -0.42; p = 0.0004).
Conclusions. Early initiation of iPCSK9 is associated with rapid achievement of target LDL-C values in ACS survivors and 4.2-fold reduction in the need for cardiovascular rehospitalizations. The use of a lipid center as a basic institution for LLT also contributes to the lower need for rehospitalizations.

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